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https://www.readbyqxmd.com/read/28239054/critical-care-management-focused-on-optimizing-brain-function-after-cardiac-arrest
#1
Ryuta Nakashima, Toru Hifumi, Kenya Kawakita, Tomoya Okazaki, Satoshi Egawa, Akihiko Inoue, Ryutaro Seo, Nobuhiro Inagaki, Yasuhiro Kuroda
The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia...
February 24, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28239053/transforming-growth-factor-beta-and-forkhead-box-o-transcription-factors-as-cardiac-fibroblast-regulators
#2
Ignacio Norambuena-Soto, Constanza Núñez-Soto, Fernanda Sanhueza-Olivares, Nicole Cancino-Arenas, David Mondaca-Ruff, Raul Vivar, Guillermo Díaz-Araya, Rosemarie Mellado, Mario Chiong
Fibroblasts play several homeostatic roles, including electrical coupling, paracrine signaling and tissue repair after injury. Fibroblasts have low secretory activity. However, in response to injury, they differentiate to myofibroblasts. These cells have an increased extracellular matrix synthesis and secretion, including collagen fibers, providing stiffness to the tissue. In pathological conditions myofibroblasts became resistant to apoptosis, remaining in the tissue, causing excessive extracellular matrix secretion and deposition, which contributes to the progressive tissue remodeling...
February 24, 2017: Bioscience Trends
https://www.readbyqxmd.com/read/28238537/defibrillation-before-ems-arrival-in-western-sweden
#3
A Claesson, J Herlitz, L Svensson, L Ottosson, L Bergfeldt, J Engdahl, C Ericson, P Sandén, C Axelsson, A Bremer
BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival. METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion...
February 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28238250/atrial-septostomy-as-a-bridge-to-replace-a-thrombosed-mechanical-aortic-valve-requiring-extracorporeal-membrane-oxygenation
#4
Adarsh Katamreddy, David F Snipelisky, Mackram F Eleid
Atrial septostomy is an infrequently used percutaneous technique to decompress either side of the heart. Here, a case is reported of atrial septostomy performed as an emergency 'bridge' procedure in a hemodynamically unstable 62-year-old man with acute mechanical prosthetic aortic valve thrombosis requiring peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO). ECMO was placed emergently as the patient suffered cardiac arrest during anesthesia induction for surgical replacement of the thrombosed prosthetic aortic valve...
September 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28238004/effects-of-therapeutic-hypothermia-for-neuroprotection-from-the-viewpoint-of-redox-regulation
#5
REVIEW
Nobuyuki Nosaka, Ayumi Okada, Hirokazu Tsukahara
Redox regulation has recently been recognized as an important factor in acute illnesses as well as in chronic diseases. It has also become a target for neuroprotection in acute intensive care. Despite its well-known therapeutic effects, therapeutic hypothermia has recently been re-evaluated for its potential use in emergency and critical care medicine. Hypothermia is an undesirable physiological condition that can increase oxidative stress and decrease anti-oxidative potency. However, many studies have shown that under ischemia/reperfusion conditions, therapeutic hypothermia actually suppresses enhanced oxidative stress and maintains or increases anti-oxidative potency...
February 2017: Acta Medica Okayama
https://www.readbyqxmd.com/read/28237918/optimal-control-of-inspired-perfluorocarbon-temperature-for-ultrafast-hypothermia-induction-by-total-liquid-ventilation-in-adult-patient-model
#6
Mathieu Nadeau, Michael Sage, Matthias Kohlhauer, Julien Mousseau, Jonathan Vandamme, Etienne Fortin-Pellerin, Jean-Paul Praud, Renaud Tissier, Herve Walti, Philippe Micheau
OBJECTIVE: Recent preclinical studies have shown that therapeutic hypothermia induced in less than 30 min by total liquid ventilation (TLV) strongly improves the survival rate after cardiac arrest. When the lung is ventilated with a breathable perfluorocarbon liquid, the inspired perfluorocarbon allows to control efficiently the cooling process of the organs. While TLV can rapidly cool animals, the cooling speed in humans remains unknown. The objective is to predict the efficiency and safety of ultrafast cooling by TLV in adult humans...
February 20, 2017: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/28237616/defining-the-diagnostic-value-of-hyperlipasemia-for-acute-pancreatitis-in-the-critically-ill
#7
Jonah Cohen, Kristin L MacArthur, Amporn Atsawarungruangkit, Michael C Perillo, Camilia R Martin, Tyler M Berzin, Nathan I Shapiro, Mandeep S Sawhney, Steven D Freedman, Sunil G Sheth
BACKGROUND/OBJECTIVES: Hyperlipasemia is frequently encountered in patients in the intensive care unit (ICU). The degree to which it should be valued in making the diagnosis of acute pancreatitis (AP) in critically ill patients remains uncertain. We sought to determine the diagnostic accuracy of hyperlipasemia and the optimal lipase cutoff for diagnosing AP in critically ill patients. METHODS: Four hundred and seventeen ICU patients with hyperlipasemia, defined as lipase greater than three times the upper limit of normal from 2009 to 2012 were retrospectively identified...
February 8, 2017: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
https://www.readbyqxmd.com/read/28237384/timely-bystander-cpr-improves-outcomes-despite-longer-ems-times
#8
Gwan Jin Park, Kyoung Jun Song, Sang Do Shin, Kyung Won Lee, Ki Ok Ahn, Eui Jung Lee, Ki Jeong Hong, Young Sun Ro
OBJECTIVES: This study aimed to determine the impact of bystander CPR on clinical outcomes in patients with increasing response time from collapse to EMS response. METHODS: A population-based observational study was conducted in patients with witnessed out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology from 2012 to 2014. The time interval from collapse to CPR by EMS providers was categorized into quartile groups: fastest group (<4min), fast group (4 to <8min), late group (8 to <15min), and latest group (15 to <30min)...
February 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28237383/the-curious-case-of-a-cardiac-tamponade-in-the-hypertensive-patient-presenting-as-abdominal-fullness
#9
William Li, Rogin Subedi, Bhaskara Madhira
Cardiac tamponade is a medical emergency consisting of an accumulation of fluid in the pericardial space which is rapidly progressing and fatal. Because cardiac tamponade is ultimately a clinical diagnosis, mindful consideration for atypical presentations is essential for the reduction of mortality in the acute setting. Our patient was a 77year-old female admitted after presenting with general malaise, weakness, somnolence, altered mental status and urinary incontinence found to have CML (chronic myeloid leukemia) on confirmatory bone marrow biopsy after suspicions arose from a leukocytosis of 34,000 cells per mcL with 85% neutrophils and elevated blasts (8%)...
January 19, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28236918/morbidity-and-mortality-after-emergency-lower-extremity-embolectomy
#10
Sergio Casillas-Berumen, Lili Sadri, Alik Farber, Mohammad H Eslami, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Jeffrey J Siracuse
OBJECTIVE: Emergency lower extremity embolectomy is a common vascular surgical procedure that has poorly defined outcomes. Our goal was to define the perioperative morbidity for emergency embolectomy and develop a risk prediction model for perioperative mortality. METHODS: The American College of Surgeons National Surgical Quality Improvement database was queried to identify patients undergoing emergency unilateral and lower extremity embolectomy. Patients with previous critical limb ischemia, bilateral embolectomy, nonemergency indication, and those undergoing concurrent bypass were excluded...
March 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28236428/targeted-simulation-and-education-to-improve-cardiac-arrest-recognition-and-telephone-assisted-cpr-in-an-emergency-medical-communication-centre
#11
Camilla Hardeland, Christiane Skåre, Jo Kramer-Johansen, Tonje Birkenes, Helge Myklebust, Andreas E Hansen, Kjetil Sunde, Theresa M Olasveengen
AIM: Recognition of cardiac arrest and prompt activation time by emergency medical dispatch are key process measures that have been associated with improved survival after out-of-hospital cardiac arrest (OHCA). The aim of this study is to improve recognition of OHCA and time to initiation of telephone assisted chest compressions in an emergency medical communication centre (EMCC). METHODS: A prospective, interventional study implementing targeted interventions in an EMCC...
February 21, 2017: Resuscitation
https://www.readbyqxmd.com/read/28235724/eeg-synchronization-measures-are-early-outcome-predictors-in-comatose-patients-after-cardiac-arrest
#12
Frédéric Zubler, Andreas Steimer, Rebekka Kurmann, Mojtaba Bandarabadi, Jan Novy, Heidemarie Gast, Mauro Oddo, Kaspar Schindler, Andrea O Rossetti
OBJECTIVE: Outcome prognostication in comatose patients after cardiac arrest (CA) remains a major challenge. Here we investigated the prognostic value of combinations of linear and non-linear bivariate EEG synchronization measures. METHODS: 94 comatose patients with EEG within 24h after CA were included. Clinical outcome was assessed at 3months using the Cerebral Performance Categories (CPC). EEG synchronization between the left and right parasagittal, and between the frontal and parietal brain regions was assessed with 4 different quantitative measures (delta power asymmetry, cross-correlation, mutual information, and transfer entropy)...
February 5, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28234810/seizure-detection-by-critical-care-providers-using-amplitude-integrated-electroencephalography-and-color-density-spectral-array-in-pediatric-cardiac-arrest-patients
#13
Geneviève Du Pont-Thibodeau, Sarah M Sanchez, Abbas F Jawad, Vinay M Nadkarni, Robert A Berg, Nicholas S Abend, Alexis A Topjian
OBJECTIVES: Determine the accuracy and confidence of critical care medicine providers to identify seizures using amplitude-integrated electroencephalography versus amplitude-integrated electroencephalography combined with color density spectral array electroencephalography (aEEG + CDSA). DESIGN: Tutorial and questionnaire. SETTING: PICU. SUBJECTS: Pediatric critical care providers (attendings, fellows, and nurses). INTERVENTIONS: A standardized powerpoint tutorial on amplitude-integrated electroencephalography and color density spectral array followed by classification of 100 amplitude-integrated electroencephalography images and 100 amplitude-integrated electroencephalography combined with color density spectral array as displaying seizures or not displaying seizures...
February 23, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28233414/the-caps-study-incidence-management-and-outcomes-of-cardiac-arrest-in-pregnancy-in-the-uk-a-prospective-descriptive-study
#14
V A Beckett, M Knight, P Sharpe
OBJECTIVE: To describe the incidence, risks, management and outcomes of cardiac arrest in pregnancy in the UK population, with specific focus on the use of perimortem caesarean section (PMCS). DESIGN: A prospective, descriptive study using the UK Obstetric Surveillance System (UKOSS). SETTING: All UK hospitals with maternity units. POPULATION: All women who received basic life support in pregnancy in the UK between 1 July 2011 and 30 June 2014 (n = 66)...
February 24, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/28232629/bet-1-can-the-value-of-end-tidal-co2-prognosticate-rosc-in-patients-coming-into-emergency-department-with-an-out-of-hospital-cardiac-arrest-oohca
#15
Harish Venkatesh, Elizabeth Keating
No abstract text is available yet for this article.
March 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28231862/electroencephalographic-recordings-during-withdrawal-of-life-sustaining-therapy-until-30-minutes-after-declaration-of-death
#16
Loretta Norton, Raechelle M Gibson, Teneille Gofton, Carolyn Benson, Sonny Dhanani, Sam D Shemie, Laura Hornby, Roxanne Ward, G Bryan Young
BACKGROUND: The timing of the circulatory determination of death for organ donation presents a medical and ethical challenge. Concerns have been raised about the timing of electrocerebral inactivity in relation to the cessation of circulatory function in organ donation after cardio-circulatory death. Nonprocessed electroencephalographic (EEG) measures have not been characterized and may provide insight into neurological function during this process. METHODS: We assessed electrocortical data in relation to cardiac function after withdrawal of life-sustaining therapy and in the postmortem period after cardiac arrest for four patients in a Canadian intensive care unit...
March 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28231684/emergency-peripartum-hysterectomy-a-challenge-or-an-obstetrical-defeat
#17
(no author information available yet)
OBJECTIVES: Peripartum hysterectomy remains an obstetric nightmare. Most obstetricians consider it a defeat. The aim of our study was to assess the prevalence, indications, procedures and complications of emergency peripartum hysterectomy (EPH) in the 2nd Department of Obstetrics & Gynecology, Medical University of Warsaw during a 7 year period (2007-2013). METHODS: A retrospective evaluation of 21,144 deliveries was performed. We analyzed all cases of EPH, including the maternal characteristics, obstetrical history, course of pregnancy and delivery, type of surgery and complications...
October 24, 2016: Neuro Endocrinology Letters
https://www.readbyqxmd.com/read/28231030/safety-of-patient-mobilization-and-rehabilitation-in-the-icu-systematic-review-with-meta-analysis
#18
Peter Nydahl, Thiti Sricharoenchai, Saurabh Chandra, Firuzan Sari Kundt, Minxuan Huang, Magdalena Fischill, Dale M Needham
BACKGROUND: Early mobilization and rehabilitation of patients in intensive care units (ICU) may improve physical function, and reduce the duration of delirium, mechanical ventilation and ICU length of stay. However, safety concerns are an important barrier to widespread implementation. OBJECTIVE: To synthesize safety data regarding patient mobilization and rehabilitation in the ICU, including falls, removal of endotracheal tubes (ETT), removal or dysfunction of intravascular catheters, removal of other catheters/tubes, cardiac arrest, hemodynamic changes and desaturation...
February 23, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28230700/therapeutic-hypothermia-doesn-t-improve-survival-or-neurologic-outcomes-after-in-hospital-cardiac-arrest
#19
Karen Rosenberg, Joan Zolot
No abstract text is available yet for this article.
March 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/28229804/immediately-functioning-grafts-from-brain-dead-donors-treated-with-extracorporeal-membrane-oxygenation
#20
Faissal A M Shaheen, Mohamed Shalabi, Ahmed Zain, Mahmood Hasanain, Abdulla Al Sayyari
A brain-dead donor experienced repeated cardiac arrests followed by severe hypotension requiring multiple vasoactive agents. These events were associated with severe lactic acidosis and dysregulated kidney function in the donor. A 10-hour treatment with extracorporeal membranous oxygenation was instituted, which was able to hemodynamically stabilize the donor. This treatment protocol resulted in the procurement of 2 viable kidney grafts transplanted into 2 recipients, who had immediate kidney graft function and excellent serum creatinine levels upon hospital discharge...
February 23, 2017: Experimental and Clinical Transplantation
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