Upper Airway Obstruction in an Adult: An Unusual Presentation-Dissection of the Cervical Aortic Arch.

Cervical aortic arch is a rare congenital anomaly. It is usually asymptomatic and an incidental finding but can have symptoms of cough, hoarseness of voice, and dysphagia. Although an association with aneurysmal dilatation is described, dissection of a cervical aortic arch is hitherto an unreported complication. We report a 46-year-old woman recently diagnosed with a cervical aortic arch, who presented with an acute upper airway obstruction leading to cardiorespiratory arrest secondary to spontaneous dissection of the cervical aortic arch. How to cite this article: Satyavolu RSN, Fischer R, Ramadoss R, Upper Airway Obstruction in an Adult: An Unusual Presentation-Dissection of the Cervical Aortic Arch. Indian J Crit Care Med 2021;25(6):732-734.

Long term outcomes for Aboriginal and Torres Strait Islander Australians after hospital intensive care.

OBJECTIVES: To assess long term outcomes for Aboriginal and Torres Strait Islander (Indigenous) Australians admitted non-electively to intensive care units (ICUs). DESIGN: Data linkage cohort study; analysis of ICU patient data (Australian and New Zealand Intensive Care Society Adult Patient Database), prospectively collected during 2007-2016. SETTING: All four university-affiliated level 3 ICUs in South Australia. MAIN OUTCOMES: Mortality (in-hospital, and 12 months and 8 years after admission to ICU), by Indigenous status. RESULTS: 2035 of 39 784 non-elective index ICU admissions (5.1%) were of Indigenous Australians, including 1461 of 37 661 patients with South Australian residential postcodes. The median age of Indigenous patients (45 years; IQR, 34-57 years) was lower than for non-Indigenous ICU patients (64 years; IQR, 47-76 years). For patients with South Australian postcodes, unadjusted mortality at discharge and 12 months and 8 years after admission was lower for Indigenous patients; after adjusting for age, sex, diabetes, severity of illness, and diagnostic group, mortality was similar for both groups at discharge (adjusted odds ratio [aOR], 0.95; 95% CI, 0.81-1.10), but greater for Indigenous patients at 12 months (aOR, 1.14; 95% CI, 1.03-1.26) and 8 years (adjusted hazard ratio, 1.23; 95% CI, 1.13-1.35). The number of potential years of life lost was greater for Indigenous patients (median, 24.0; IQR, 15.8-31.8 v 12.5; IQR, 0-22.3), but, referenced to respective population life expectancies, relative survival at 8 years was similar (proportions: Indigenous, 0.78; 95% CI, 0.75-0.80; non-Indigenous, 0.77; 95% CI, 0.76-0.78). CONCLUSIONS: Adjusted long term mortality and median number of potential life years lost are higher for Indigenous than non-Indigenous patients after intensive care in hospital. These differences reflect underlying population survival patterns rather than the effects of ICU admission.

Early clinical prediction of neurological outcome following out of hospital cardiac arrest managed with therapeutic hypothermia.

BACKGROUND: Therapeutic hypothermia (TH) may improve neurological outcome in comatose patients following out of hospital cardiac arrest (OHCA). The reliability of clinical prediction of neurological outcome following TH remains unclear. In particular, there is very limited data on survival and predictors of neurological outcome following TH for OHCA from resource-constrained settings in general and South Asia in specific. OBJECTIVE: The objective was to identify factors predicting unfavorable neurological outcome at hospital discharge in comatose survivors of OHCA treated with hypothermia. DESIGN: Retrospective chart review. SETTING: Urban 200-bed hospital in Chennai, India. METHODS: Predictors of unfavorable neurological outcome (cerebral performance category score [3-5]) at hospital discharge were evaluated among patients admitted between January 2006 and December 2012 following OHCA treated with TH. Hypothermia was induced with cold intravenous saline bolus, ice packs and cold-water spray with bedside fan. Predictors of unfavorable neurological outcome were examined through multivariate exact logistic regression analysis. RESULTS: A total of 121 patients were included with 106/121 (87%) experiencing the unfavorable neurological outcome. Independent predictors of unfavorable neurological outcome included: Status myoclonus <24 h (odds ratio [OR] 21.79, 95% confidence interval [CI] 2.89-Infinite), absent brainstem reflexes (OR 50.09, 6.55-Infinite), and motor response worse than flexion on day 3 (OR 99.41, 12.21-Infinite). All 3 variables had 100% specificity and positive predictive value. CONCLUSION: Status myoclonus within 24 h, absence of brainstem reflexes and motor response worse than flexion on day 3 reliably predict unfavorable neurological outcome in comatose patients with OHCA treated with TH.