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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541993

RESUMO

Acute pulmonary embolism is a frequent potentially reversible cause of sudden cardiac arrest. The early diagnosis is challenging but essential for further treatment. New therapeutic options in resuscitation, such as extracorporeal resuscitation, are leading to frequent transports of patients to emergency rooms with ongoing resuscitation. A transoesophageal echo performed during resuscitation can give hints for reversible causes for the cardiac arrest. We present a case of a 40-year-old female patient who was transferred to our department with ongoing resuscitation and received a transoesophageal echo immediately on arrival. The examination showed a massive intracardiac thrombus. The subsequent thrombolysis and following resuscitation were observed and documented via transoesophageal echo.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Trombose/complicações , Adulto , Reanimação Cardiopulmonar/efeitos adversos , Ecocardiografia Transesofagiana , Feminino , Humanos
2.
Resuscitation ; 159: 28-34, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33338570

RESUMO

AIM: It remains unclear whether cardiac arrest (CA) resuscitation generates aerosols that can transmit respiratory pathogens. We hypothesize that chest compression and defibrillation generate aerosols that could contain the SARS-CoV-2 virus in a swine CA model. METHODS: To simulate witnessed CA with bystander-initiated cardiopulmonary resuscitation, 3 female non-intubated swine underwent 4 min of ventricular fibrillation without chest compression or defibrillation (no-flow) followed by ten 2-min cycles of mechanical chest compression and defibrillation without ventilation. The diameter (0.3-10 µm) and quantity of aerosols generated during 45-s intervals of no-flow and chest compression before and after defibrillation were analyzed by a particle analyzer. Aerosols generated from the coughs of 4 healthy human subjects were also compared to aerosols generated by swine. RESULTS: There was no significant difference between the total aerosols generated during chest compression before defibrillation compared to no-flow. In contrast, chest compression after defibrillation generated significantly more aerosols than chest compression before defibrillation or no-flow (72.4 ±â€¯41.6 × 104 vs 12.3 ±â€¯8.3 × 104 vs 10.5 ±â€¯11.2 × 104; p < 0.05), with a shift in particle size toward larger aerosols. Two consecutive human coughs generated 54.7 ±â€¯33.9 × 104 aerosols with a size distribution smaller than post-defibrillation chest compression. CONCLUSIONS: Chest compressions alone did not cause significant aerosol generation in this swine model. However, increased aerosol generation was detected during chest compression immediately following defibrillation. Additional research is needed to elucidate the clinical significance and mechanisms by which aerosol generation during chest compression is modified by defibrillation.


Assuntos
Aerossóis/análise , Reanimação Cardiopulmonar/efeitos adversos , Massagem Cardíaca/efeitos adversos , Parada Cardíaca Extra-Hospitalar/terapia , Animais , Feminino , Humanos , Projetos Piloto , Suínos
3.
Sci Rep ; 10(1): 22180, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33335205

RESUMO

Precise criteria for extracorporeal cardiopulmonary resuscitation (ECPR) are still lacking in patients with out-of-hospital cardiac arrest (OHCA). We aimed to investigate whether adopting our hypothesized criteria for ECPR to patients with refractory OHCA could benefit. This before-after study compared 4.5 years after implementation of ECPR for refractory OHCA patients who met our criteria (Jan, 2015 to May, 2019) and 4 years of undergoing conventional CPR (CCPR) prior to ECPR with patients who met the criteria (Jan, 2011 to Jan, 2014) in the emergency department. The primary and secondary outcomes were good neurologic outcome at 6-months and 1-month respectively, defined as 1 or 2 on the Cerebral Performance Category score. A total of 70 patients (40 with CCPR and 30 with ECPR) were included. For a good neurologic status at 6-months and 1-month, patients with ECPR (33.3%, 26.7%) were superior to those with CCPR (5.0%, 5.0%) (all Ps < 0.05). Among patients with ECPR, a group with a good neurologic status showed shorter low-flow time, longer extracorporeal membrane oxygenation duration and hospital stays, and lower epinephrine doses used (all Ps < 0.05). The application of the detailed indication before initiating ECPR appears to increase a good neurologic outcome rate.


Assuntos
Reanimação Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Tomada de Decisão Clínica , Comorbidade , Árvores de Decisões , Gerenciamento Clínico , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Resultados da Assistência ao Paciente , Seleção de Pacientes , Taxa de Sobrevida
4.
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
5.
J Card Surg ; 35(10): 2821-2824, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043655

RESUMO

A patient with acute pulmonary embolism suffered cardiac arrest, received manual and mechanical cardiopulmonary resuscitation and tissue plasminogen activator before extracorporeal cardiopulmonary resuscitation was initiated. She suffered a type B aortic dissection and retroperitoneal hemorrhage secondary to resuscitation measures. This case report describes high-risk anticoagulation management for contradicting treatment goals in preparation for pulmonary embolectomy on cardiopulmonary bypass.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Aórtico/etiologia , Reanimação Cardiopulmonar/efeitos adversos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Hemorragia/etiologia , Embolia Pulmonar/etiologia , Espaço Retroperitoneal , Ponte Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Contraindicações , Embolectomia , Feminino , Parada Cardíaca/etiologia , Humanos , Pessoa de Meia-Idade , Ativadores de Plasminogênio/administração & dosagem , Ativadores de Plasminogênio/efeitos adversos
6.
Cell ; 183(1): 16-27.e1, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32882182

RESUMO

Neurological complications have emerged as a significant cause of morbidity and mortality in the ongoing COVID-19 pandemic. Beside respiratory insufficiency, many hospitalized patients exhibit neurological manifestations ranging from headache and loss of smell, to confusion and disabling strokes. COVID-19 is also anticipated to take a toll on the nervous system in the long term. Here, we will provide a critical appraisal of the potential for neurotropism and mechanisms of neuropathogenesis of SARS-CoV-2 as they relate to the acute and chronic neurological consequences of the infection. Finally, we will examine potential avenues for future research and therapeutic development.


Assuntos
Encefalopatias/etiologia , Infecções por Coronavirus/complicações , Transtornos do Olfato/etiologia , Pneumonia Viral/complicações , Acidente Vascular Cerebral/etiologia , Animais , Encefalopatias/epidemiologia , Reanimação Cardiopulmonar/efeitos adversos , Infecções por Coronavirus/terapia , Humanos , Transtornos do Olfato/epidemiologia , Pandemias , Pneumonia Viral/terapia , Acidente Vascular Cerebral/epidemiologia
7.
Medicine (Baltimore) ; 99(33): e21685, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872040

RESUMO

Chest injuries are common and inevitable complications of chest compressions during cardiopulmonary resuscitation (CPR). This study aimed to investigate lung parenchymal and thoracic skeletal injuries after CPR by using computed tomography (CT) and to analyze the correlation between the duration of CPR and related complications.We examined 43 non-traumatic cardiac arrest patients who were successfully resuscitated after CPR and had chest CT scans within 24 hours of CPR. Lung parenchymal injuries were assessed by quantifying the lung contusion score (LCS) on the CT images, and each skeletal injury was investigated by classifying the location and the distribution. Other CPR-related chest injuries were also described, such as pleural effusion/hemothorax, pneumothorax, and retrosternal hematoma. Statistical analysis was conducted to determine whether the duration of CPR was correlated with each complication.Lung contusions were found in all of the patients (mean LCS: 22, range: 5-47). The distribution of lung contusions were predominantly in the bilateral dependent portions of the lungs (41 patients). All of the rib fractures occurred in the anterior arc (43 patients), and the sternal fractures occurred predominantly in the mid-sternal body (31 patients). In patients younger than 70 years old, the number of rib fractures significantly increased among those who underwent CPR for more than 25 minutes compared to those who received CPR for less than 25 minutes (median 4.5 vs 9; mean 8.3 vs 5.6 per person, respectively; P = .035). The risk of sternal fracture tended to be higher for patients who received CPR for more than 10 minutes compared to those who received CPR for less than 10 minutes (odds ratio: 3.60; 95% confidence interval: 0.86-15.06; P = .079). However, there was no statistically significant correlation between the duration of CPR and LCS or other CPR-related chest injuries.The duration of CPR was associated with the number of rib fractures and the occurrence of sternal fractures, but it did not affect the extent of CPR-related lung contusions or other CPR-related chest injuries. All of the rib fractures occurred in the anterior arc, while the sternal fractures occurred predominantly in the mid-sternal body. However, since this study was conducted in a single institution, the number of patients included was relatively small, thus limiting the statistical analysis.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Lesão Pulmonar/diagnóstico por imagem , Fraturas das Costelas/diagnóstico por imagem , Esterno/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Criança , Feminino , Humanos , Lesão Pulmonar/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Fraturas das Costelas/etiologia , Esterno/lesões , Fatores de Tempo , Adulto Jovem
8.
Clin Med (Lond) ; 20(5): e154-e159, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620591

RESUMO

There is disagreement between international guidelines on the level of personal protective equipment (PPE) required for chest compressions for patients with suspected COVID-19. This discrepancy centres on whether they are considered to be an aerosol-generating procedure (AGP), thus requiring airborne protection to prevent transmission to healthcare workers (HCWs). The need to don higher-level PPE has to be weighed against the resulting delay to emergency treatment.We performed a literature search on this topic which found eight relevant studies. All were observational with low patient numbers and multiple confounding factors, but describe cases of acute respiratory infection transmission during chest compressions. One systematic review concluded that chest compressions were not an AGP. Two simulated studies (released as preprints) potentially demonstrate aerosol generation. Given that there is evidence for infection transmission during chest compressions, we conclude that a precautionary approach with appropriate PPE is necessary to protect HCW from contracting a potentially fatal infection.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Aerossóis/efeitos adversos , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Saúde do Trabalhador , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente , Pneumonia Viral/epidemiologia , Reino Unido
9.
J Card Surg ; 35(8): 2064-2066, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652795

RESUMO

A flail chest can occur when cardiopulmonary resuscitation causes extensive rib fractures. Despite successful cardiopulmonary resuscitation, if the flail chest is not treated, the patient may not survive regardless of the correction of the primary condition that caused the cardiac arrest. Therefore, if flail chest persists despite the appropriate conservative management to correct the flail chest, active surgical management is essential. We present a successful surgical treatment with a pectus bar for a patient with flail chest, caused by extensive segmental rib fractures sustained during cardiopulmonary resuscitation for a massive pulmonary thromboembolism.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Tórax Fundido/etiologia , Tórax Fundido/cirurgia , Fixação Interna de Fraturas/métodos , Fixadores Internos , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Feminino , Tórax Fundido/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Radiografia Torácica , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/etiologia , Fraturas das Costelas/cirurgia , Costelas/cirurgia , Tomografia Computadorizada por Raios X
11.
PLoS One ; 15(6): e0228693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574159

RESUMO

BACKGROUND: Sustained inflation (SI) during chest compression (CC = CC+SI) has been recently shown as an alternative method during cardiopulmonary resuscitation in neonates. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery is unknown. OBJECTIVE: To examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets. METHODS: Twenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n = 8), a PIP of 20 cmH2O (CC+SI_PIP_20, n = 8), a PIP of 30 cmH2O (CC+SI_PIP_30, n = 8), and a sham-operated control group (n = 5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. RESULTS: Baseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume (VT) and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p = 0.56 and p = 0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1ß and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls). CONCLUSION: In asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.


Assuntos
Asfixia/terapia , Reanimação Cardiopulmonar/efeitos adversos , Insuflação/efeitos adversos , Pressão , Animais , Animais Recém-Nascidos , Lesões Encefálicas/etiologia , Hemodinâmica , Recuperação de Função Fisiológica , Respiração , Suínos
13.
Am J Emerg Med ; 38(8): 1701.e1-1701.e2, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32389400

RESUMO

This paper reports a case of paradoxical embolism of right heart thrombi visualized on transesophageal echocardiography during cardiopulmonary resuscitation (CPR). CPR may cause a right-to-left shunt by producing a sudden increase in right atrial pressure during the compression phase. In cardiac arrest patients with right heart thrombi who have received CPR, systemic embolization can occur owing to paradoxical embolism.


Assuntos
Reanimação Cardiopulmonar/efeitos adversos , Embolia Paradoxal/etiologia , Cardiopatias/etiologia , Idoso de 80 Anos ou mais , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Evolução Fatal , Cardiopatias/diagnóstico por imagem , Humanos , Masculino , Parada Cardíaca Extra-Hospitalar/terapia , Trombose/diagnóstico por imagem , Trombose/etiologia
14.
J Surg Res ; 253: 18-25, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32311580

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular adjunct to hemorrhage control. Success relies on institutional support and focused training in arterial access. We hypothesized that hospitals with higher REBOA volumes will be more successful than low-volume hospitals at aortic occlusion with REBOA. METHODS: This is a retrospective study from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry from November 2013 to January 2018. Patients aged ≥18 y who underwent REBOA were included. Successful placement of REBOA catheters (defined as hemodynamic improvement with balloon inflation) was compared between high-volume (≥80 cases; two hospitals), mid-volume (10-20 cases; four hospitals), and low-volume (<10 cases; 14 hospitals) hospitals, adjusting for patient factors. RESULTS: Of 271 patients from 20 hospitals, 210 patients (77.5%) had successful REBOA placement. Most patients were male (76.0%) and sustained blunt trauma (78.1%). cardiopulmonary resuscitation (CPR) was ongoing at the time of REBOA placement in 34.5% of patients. Inpatient mortality was 67.4%, unchanged by hospital volume. Multivariable logistic regression found increased odds of successful REBOA placement at high-volume versus low-volume hospitals (odds ratio [OR], 7.50; 95% confidence interval [CI], 2.10-27.29; P = 0.002) and mid-volume versus low-volume hospitals (OR, 7.82; 95% CI, 1.52-40.31; P = 0.014) and decreased odds among patients undergoing CPR during REBOA placement (OR, 0.10; 95% CI, 0.03-0.34; P < 0.001) when adjusting for age, sex, mechanism of injury, prehospital CPR, CPR on admission, transfer status, hospital location of REBOA placement, Glasgow Coma Scale ≤ 13, and injury severity. CONCLUSIONS: Hospitals with higher REBOA volumes were more likely to achieve hemodynamic improvement with REBOA inflation. However, mortality and complication rates were unchanged. Independent of hospital volume, ongoing CPR is associated with a decreased odds of successful REBOA placement.


Assuntos
Oclusão com Balão/métodos , Reanimação Cardiopulmonar/educação , Procedimentos Endovasculares/educação , Hemorragia/terapia , Complicações Pós-Operatórias/prevenção & controle , Traumatismos Torácicos/terapia , Adulto , Aorta/cirurgia , Oclusão com Balão/efeitos adversos , Oclusão com Balão/instrumentação , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Educação Médica Continuada/organização & administração , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/organização & administração , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Cirurgiões/educação , Traumatismos Torácicos/complicações , Traumatismos Torácicos/mortalidade , Resultado do Tratamento , Dispositivos de Acesso Vascular/efeitos adversos , Adulto Jovem
15.
Anaesthesia ; 75(8): 1086-1095, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32311771

RESUMO

Healthcare workers are at risk of infection during the severe acute respiratory syndrome coronavirus-2 pandemic. International guidance suggests direct droplet transmission is likely and airborne transmission occurs only with aerosol-generating procedures. Recommendations determining infection control measures to ensure healthcare worker safety follow these presumptions. Three mechanisms have been described for the production of smaller sized respiratory particles ('aerosols') that, if inhaled, can deposit in the distal airways. These include: laryngeal activity such as talking and coughing; high velocity gas flow; and cyclical opening and closure of terminal airways. Sneezing and coughing are effective aerosol generators, but all forms of expiration produce particles across a range of sizes. The 5-µm diameter threshold used to differentiate droplet from airborne is an over-simplification of multiple complex, poorly understood biological and physical variables. The evidence defining aerosol-generating procedures comes largely from low-quality case and cohort studies where the exact mode of transmission is unknown as aerosol production was never quantified. We propose that transmission is associated with time in proximity to severe acute respiratory syndrome coronavirus-1 patients with respiratory symptoms, rather than the procedures per se. There is no proven relation between any aerosol-generating procedure with airborne viral content with the exception of bronchoscopy and suctioning. The mechanism for severe acute respiratory syndrome coronavirus-2 transmission is unknown but the evidence suggestive of airborne spread is growing. We speculate that infected patients who cough, have high work of breathing, increased closing capacity and altered respiratory tract lining fluid will be significant producers of pathogenic aerosols. We suggest several aerosol-generating procedures may in fact result in less pathogen aerosolisation than a dyspnoeic and coughing patient. Healthcare workers should appraise the current evidence regarding transmission and apply this to the local infection prevalence. Measures to mitigate airborne transmission should be employed at times of risk. However, the mechanisms and risk factors for transmission are largely unconfirmed. Whilst awaiting robust evidence, a precautionary approach should be considered to assure healthcare worker safety.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional , Pneumonia Viral/transmissão , Aerossóis , Microbiologia do Ar , Reanimação Cardiopulmonar/efeitos adversos , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Expiração/fisiologia , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras , Nebulizadores e Vaporizadores , Pandemias/prevenção & controle , Tamanho da Partícula , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Fenômenos Fisiológicos Respiratórios
17.
Circ J ; 84(5): 820-824, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32188835

RESUMO

BACKGROUND: To take full advantage of transesophageal echocardiography (TEE) during cardiopulmonary resuscitation (CPR), we propose a flowchart derived from representative cases.Methods and Results:TEE was used in patients requiring CPR to obtain information potentially helpful for rescue. TEE navigated the CPR procedures (navigation TEE), identified the possible cause of arrest (focus TEE), and optimized treatment while checking for pitfalls (secure TEE). In addition, TEE corrected prehospital misdiagnoses and detected new complications caused by CPR. CONCLUSIONS: TEE provides valuable information without interrupting CPR procedures. It is hoped that our flowchart may facilitate goal-directed, efficient assessment.


Assuntos
Reanimação Cardiopulmonar , Ecocardiografia Transesofagiana , Parada Cardíaca/diagnóstico por imagem , Parada Cardíaca/terapia , Adulto , Idoso , Reanimação Cardiopulmonar/efeitos adversos , Erros de Diagnóstico , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Gravidez , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Resultado do Tratamento
18.
19.
J Forensic Leg Med ; 70: 101918, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32090973

RESUMO

INTRODUCTION: Chest compression is regarded as a vital component of CPR and should be initiated immediately upon recognition of cardiac arrest in order to preserve circulation and thereby maintaining vital functions. Mechanical devices for CPR are still more common in the pre- and in-hospital treatment of cardiac arrest. Injuries due to treatment with these are known to occur. The aim of this case series was to identify and characterize the injury pattern in patients who had received mechanical CPR with focus on the visceral injuries. METHOD: From 2016 to 2018, we prospectively included all patients who had received out-of-hospital mech-CPR with a LUCAS device in the Region of Southern Denmark (RSD) who were subsequently autopsied. Both hospital and forensic autopsies were included. We excluded cases with age less than 18, trauma immediately preceding the cardiac arrest, or known pregnancy. RESULTS: A total number of 50 cases were included in this study. Overall, 38 (76%) had injuries. In the remaining 12 cases (24%) we found neither skeletal or visceral injuries nor any bruising of the chest. 11 (22%) had visceral injuries. Four patients suffered abdominal injuries. The remaining patients had thoracic injuries only. In five cases, the pathologist considered the injuries life-threatening had the patients otherwise survived. These five cases were less than 55 years old and had no known or observed conditions which could explain the extend of injury. CONCLUSION: We found five iatrogenic injuries which in itself could have been fatal had the patients survived the incident. It is of great importance for the forensic pathologists to be aware of the possible types of injuries and their severity caused by compressions when dealing with patients treated with mechanical CPR as they are both diverse and can be extensive.


Assuntos
Traumatismos Abdominais/etiologia , Reanimação Cardiopulmonar/efeitos adversos , Traumatismos Torácicos/etiologia , Adulto , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Wilderness Environ Med ; 31(1): 97-100, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044210

RESUMO

We experienced a case involving prolonged cardiopulmonary resuscitation (CPR) during cardiac arrest on Mt. Fuji (3776 m), demanding lengthy exertion by the rescuers performing CPR. Considering the effects of exertion on the rescuers, we examined their percutaneous arterial oxygen saturation during simulated CPR and compared the effects of compression-only and conventional CPR at 3700 m above sea level. The effects of CPR on the physical condition of rescuers were examined at the summit of Mt. Fuji: three rescue staff equipped with pulse-oximeters performed CPR with or without breaths using a CPR mannequin. At 3700 m, the rescuers' heart rate increased during CPR regardless of the presence or absence of rescue breathing. Percutaneous arterial oxygen saturation measured in such an environment was reduced only when CPR without rescue breathing was performed. Scores on the Borg scale, a subjective score of fatigue, after CPR in a 3700 m environment were 13 to 15 of 20 (somewhat hard to hard). Performing CPR at high altitude exerts a significant physical effect upon the condition of rescuers. Compression-only CPR at high altitude may cause a deterioration in rescuer oxygenation, whereas CPR with rescue breathing might ameliorate such deterioration.


Assuntos
Artérias/fisiologia , Reanimação Cardiopulmonar/efeitos adversos , Montanhismo , Oxigênio/sangue , Trabalho de Resgate , Adulto , Altitude , Frequência Cardíaca , Humanos , Japão , Masculino , Manequins , Pessoa de Meia-Idade , Oximetria , Pressão
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