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Epinephrine cardiac arrest

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https://www.readbyqxmd.com/read/29663283/eeg-artifact-versus-subclinical-status-epilepticus-in-a-patient-following-cardiac-arrest
#1
Jean E Cibula, Daniel S Demos, Brenda G Fahy
BACKGROUND: A challenge in ICU EEG interpretation is identifying subclinical status epilepticus versus patterns on the ictal-interictal continuum versus other repetitive patterns. In the electrically noisy intensive care unit, identifying and eliminating interference and artifact allow accurate diagnoses from the EEG, avoiding unnecessary treatment or sedation. METHODS: We present a case during Impella (Abiomed Inc, Danvers, MA) continuous flow left ventricular assist device use where the EEG artifact was initially misinterpreted as seizure by the resident and treated as status epilepticus because of the "focal" sharply contoured repetitive pattern...
April 16, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29652719/vasopressors-during-cardiopulmonary-resuscitation-a-network-meta-analysis-of-randomized-trials
#2
Alessandro Belletti, Umberto Benedetto, Alessandro Putzu, Enrico A Martino, Giuseppe Biondi-Zoccai, Gianni D Angelini, Alberto Zangrillo, Giovanni Landoni
OBJECTIVES: Several randomized controlled trials have compared adrenaline (epinephrine) with alternative therapies in patients with cardiac arrest with conflicting results. Recent observational studies suggest that adrenaline might increase return of spontaneous circulation but worsen neurologic outcome. We systematically compared all the vasopressors tested in randomized controlled trials in adult cardiac arrest patients in order to identify the treatment associated with the highest rate of return of spontaneous circulation, survival, and good neurologic outcome...
May 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29572320/decreased-camp-level-and-decreased-downregulation-of-%C3%AE-1-adrenoceptor-expression-in-therapeutic-hypothermia-resuscitated-myocardium-are-associated-with-improved-post-resuscitation-myocardial-function
#3
Wei Wang, Tianfeng Hua, Hao Li, Xiaobo Wu, Jennifer Bradley, Mary Ann Peberdy, Joseph P Ornato, Wanchun Tang
BACKGROUND: Epinephrine administered during cardiopulmonary resuscitation (CPR) is associated with severe post-resuscitation myocardial dysfunction. We previously demonstrated that therapeutic hypothermia reduced the severity of post-resuscitation myocardial dysfunction caused by epinephrine; however, the relationship between myocardial adrenoceptor expression and myocardial protective effects by hypothermia remains unclear. METHODS AND RESULTS: Rats weighing between 450 and 550 g were randomized into 5 groups: (1) normothermic placebo, (2) normothermic epinephrine, (3) hypothermic placebo, (4) hypothermic epinephrine, and (5) sham (not subject to cardiac arrest and resuscitation)...
March 23, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29526678/physiologic-response-to-pre-arrest-bolus-dilute-epinephrine-in-the-pediatric-intensive-care-unit
#4
Catherine E Ross, Lisa A Asaro, David Wypij, Conor C Holland, Michael W Donnino, Monica E Kleinman
AIM: To quantify the physiologic effects of pre-arrest bolus dilute epinephrine in the pediatric intensive care unit. METHODS: Patients <18 years old and ≥37 weeks gestation who received an intravenous bolus of dilute epinephrine (10 mcg/mL) in the pediatric intensive care units at our institution from January 2011 to March 2017 were retrospectively identified. Patients were excluded if doses exceeded 20 mcg/kg, or under the following circumstances: orders limiting resuscitation, extracorporeal membrane oxygenation, active chest compressions, simultaneous administration of other blood pressure-altering interventions or documented normotension prior to epinephrine...
March 8, 2018: Resuscitation
https://www.readbyqxmd.com/read/29519282/-profile-and-outcome-of-cardiopulmonary-resuscitation-after-sudden-cardiac-arrests-in-the-emergency-department-a-multicenter-prospective-observational-study
#5
Yingying Hu, Jun Xu, Huadong Zhu, Guoxiu Zhang, Feng Sun, Yazhi Zhang, Xuezhong Yu
OBJECTIVE: To investigate the status of cardiopulmonary resuscitation (CPR) in patients with sudden cardiac arrest (CA) in the emergency department. METHODS: A multicenter prospective observational study was conducted. The patients with CA admitted to 13 hospitals from 6 provinces in four different regions, including North China, Southern China, East China, Southwest China, from July 1st, 2015 to July 31st, 2017 were enrolled. A modified Utstein template was applied to collect clinical data, including general data, CA related data and prognosis, and primary outcome indicator was the return of spontaneous circulation (ROSC) rate, and the secondary outcome indicator was 28-day survival rate...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29511001/time-to-epinephrine-administration-and-survival-from-non-shockable-out-of-hospital-cardiac-arrest-among-children-and-adults
#6
Matthew Hansen, Robert H Schmicker, Craig D Newgard, Brian Grunau, Frank Scheuermeyer, Sheldon Cheskes, Veer Vithalani, Fuad Alnaji, Thomas Rea, Ahamed H Idris, Heather Herren, Jamie Hutchison, Mike Austin, Debra Egan, Mohamud Daya
Background -Previous studies have demonstrated that earlier epinephrine administration is associated with improved survival from out-of-hospital cardiac arrest (OHCA) with shockable initial rhythms. However, the effect of epinephrine timing on patients with non-shockable initial rhythms is unclear. The objective of this study was to measure the association between time to epinephrine administration and survival in adults and children with EMS-treated OHCA with non-shockable initial rhythms. Methods -We performed a secondary analysis of OHCAs prospectively identified by the Resuscitation Outcomes Consortium (ROC) network from June 4, 2011 to June 30, 2015...
March 6, 2018: Circulation
https://www.readbyqxmd.com/read/29508418/synchronized-pulsatile-flow-with-low-systolic-output-from-veno-arterial-extracorporeal-membrane-oxygenation-improves-myocardial-recovery-after-experimental-cardiac-arrest-in-pigs
#7
Sebastian Voicu, Georgios Sideris, Jean-Guillaume Dillinger, Demetris Yannopoulos, Nicolas Deye, Chantal Kang, Michel Bonneau, Jason Bartos, Antoni Kedra, Sophie Bailliart, Adrien Pasteur-Rousseau, Guy Amah, Philippe Bonnin, Jacques Callebert, Patrick Henry, Bruno Megarbane
Circulatory failure following cardiac arrest (CA) requires catecholamine support and occasionally veno-arterial extracorporeal membrane oxygenation (vaECMO). VaECMO-generated blood flow is continuous and retrograde, increasing ventricular stroke work. Our aim was to assess the benefit of a device generating a pulsatile vaECMO flow synchronized with the heart rhythm lowering systolic vaECMO output on the left ventricular ejection fraction (LVEF) and pulmonary capillary pressure (Pcap) after CA. This experimental randomized study in pigs compared standard nonpulsatile vaECMO (control) with pulsatile synchronized vaECMO (study) group using a pulsatility-generating device...
March 6, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29425976/non-invasive-characterization-of-hemodynamics-in-adult-out-of-hospital-cardiac-arrest-patients-soon-after-return-of-spontaneous-circulation
#8
Joseph P Ornato, Tammy Nguyen, Peter Moffett, Stephen Miller, Michael J Vitto, David Evans, Alan Payne, Kathy Baker, Mary Schaeffer
BACKGROUND: Little is known about hemodynamics in adult, out-of-hospital (OHCA) patients following return of spontaneous circulation (ROSC). A 1994 study when "high-dose epinephrine" use was common showed consistently elevated systemic vascular resistance (SVR) lasting ≥6 h in 49 adult patients after return of spontaneous circulation (ROSC). STUDY AIM: To characterize hemodynamic abnormalities in adult OHCA patients soon after ROSC. Our hypothesis was that, unlike the consistently high SVR values reported when "high-dose" epinephrine was in common use, there would be a more heterogenous distribution of SVR values using current adrenergic therapy...
April 2018: Resuscitation
https://www.readbyqxmd.com/read/29419933/a-serious-adverse-event-secondary-to-rapid-intravenous-levetiracetam-injection-in-a-dog
#9
Allison A Biddick, Lenore M Bacek, Amanda R Taylor
OBJECTIVE: To describe a serious adverse event as a result of rapid intravenous injection of undiluted levetiracetam in a dog. CASE SUMMARY: An 8-year-old female spayed Chihuahua was evaluated for cluster seizures and tachypnea. The patient was administered an intravenous dose of undiluted levetiracetam (60 mg/kg) and immediately developed tachycardia, hyperglycemia, hypotension, and a dull mentation. The patient's blood pressure and mentation did not respond to intravenous fluid boluses but improved immediately after administration of epinephrine intravenously...
February 8, 2018: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/29413238/should-we-perform-an-immediate-coronary-angiogram-in-all-patients-after-cardiac-arrest-insights-from-a-large-french-registry
#10
Wulfran Bougouin, Florence Dumas, Nicole Karam, Carole Maupain, Eloi Marijon, Lionel Lamhaut, Daniel Jost, Guillaume Geri, Frankie Beganton, Olivier Varenne, Christian Spaulding, Xavier Jouven, Alain Cariou
OBJECTIVES: This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival. BACKGROUND: An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases. METHODS: From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France)...
February 12, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29393490/erythropoietin-alleviates-post-resuscitation-myocardial-dysfunction-in-rats-potentially-through-increasing-the-expression-of-angiotensin-ii-receptor-type-2-in-myocardial-tissues
#11
Hourong Zhou, Jia Huang, Li Zhu, Yu Cao
Activation of renin-angiotensin system (RAS) is one of the pathological mechanisms associated with myocardial ischemia-reperfusion injury following resuscitation. The present study aimed to determine whether erythropoietin (EPO) improves post‑resuscitation myocardial dysfunction and how it affects the renin‑angiotensin system. Sprague‑Dawley rats were randomly divided into sham, vehicle, epinephrine (EP), EPO and EP + EPO groups. Excluding the sham group, all groups underwent cardiopulmonary resuscitation (CPR) 4 min after asphyxia‑induced cardiac arrest (CA)...
January 24, 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29392079/novel-modification-of-potassium-chloride-induced-cardiac-arrest-model-for-aged-mice
#12
Huaqin Liu, Zhui Yu, Ying Li, Bin Xu, Baihui Yan, Wulf Paschen, David S Warner, Wei Yang, Huaxin Sheng
Experimental cardiac arrest (CA) in aging research is infrequently studied in part due to the limitation of animal models. We aimed to develop an easily performed mouse CA model to meet this need. A standard mouse KCl-induced CA model using chest compressions and intravenous epinephrine for resuscitation was modified by blood withdrawal prior to CA onset, so as to decrease the requisite KCl dose to induce CA by decreasing the circulating blood volume. The modification was then compared to the standard model in young adult mice subjected to 8 min CA...
February 2018: Aging and Disease
https://www.readbyqxmd.com/read/29373368/adenosine-2a-receptor-activation-attenuates-ischemia-reperfusion-injury-during-extracorporeal-cardiopulmonary-resuscitation
#13
James H Mehaffey, Dustin Money, Eric J Charles, Sarah Schubert, Angela Fernandez Piñeros, Di Wu, Sai Vineela Bontha, Robert Hawkins, Nicholas R Teman, Victor E Laubach, Valeria R Mas, Curtis G Tribble, Daniel G Maluf, Ashish K Sharma, Zequan Yang, Irving L Kron, Mark E Roeser
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...
January 25, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29351501/pediatric-anaphylaxis-in-the-prehospital-setting-incidence-characteristics-and-management
#14
Emily Andrew, Ziad Nehme, Stephen Bernard, Karen Smith
OBJECTIVE: Although hospital presentations for pediatric anaphylaxis have been described in the literature, a minimal amount is known regarding the incidence, characteristics, and management of pediatric anaphylaxis presenting to emergency medical services (EMS). METHODS: We performed a retrospective observational study of pediatrics (≤16 years) presenting to EMS in Victoria, Australia. Patients with suspected anaphylaxis were included if they were treated with epinephrine before or after EMS arrival...
January 19, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29305926/lower-dose-epinephrine-administration-and-out-of-hospital-cardiac-arrest-outcomes
#15
Cameron A Fisk, Michele Olsufka, Lihua Yin, Andrew M McCoy, Andrew J Latimer, Charles Maynard, Graham Nichol, Jonathan Larsen, Leonard A Cobb, Michael R Sayre
BACKGROUND: International guidelines recommend administration of 1 mg of intravenous epinephrine every 3-5 min during cardiac arrest. The optimal dose of epinephrine is not known. We evaluated the association of reduced frequency and dose of epinephrine with survival after out-of-hospital cardiac arrest (OHCA). METHODS: Included were patients with non-traumatic OHCA treated by advanced life support (ALS) providers from January 1, 2008 to June 30, 2016. During the before period, providers were instructed to give epinephrine 1 mg intravenously at 4 min followed by additional 1 mg doses every eight minutes to patients with OHCA with a shockable rhythm and 1 mg doses every two minutes to patients with a non-shockable rhythm (higher dose)...
March 2018: Resuscitation
https://www.readbyqxmd.com/read/29279412/association-between-prompt-defibrillation-and-epinephrine-treatment-with-long-term-survival-after-in-hospital-cardiac-arrest
#16
Krishna K Patel, John A Spertus, Yevgeniy Khariton, Yuanyuan Tang, Lesley H Curtis, Paul S Chan
Background -Prior studies have reported higher in-hospital survival with prompt defibrillation and epinephrine treatment in patients suffering in-hospital cardiac arrest (IHCA). Whether this survival benefit persists after discharge is unknown. Methods -We linked data from a national IHCA registry with Medicare files and identified 36,961 patients aged ≥65 years with an IHCA at 517 hospitals between 2000 and 2011. Patients with IHCA due to pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) were stratified by prompt (≤2 min) vs...
December 26, 2017: Circulation
https://www.readbyqxmd.com/read/29206063/age-discrimination-in-out-of-hospital-cardiac-arrest-care-a-case-control-study
#17
Eric Wiel, Christophe Di Pompéo, Nicolas Segal, Gérald Luc, Jean-Baptiste Marc, Carine Vanderstraeten, Carlos El Khoury, Joséphine Escutnaire, Karim Tazarourte, Pierre-Yves Gueugniaud, Hervé Hubert
BACKGROUND: Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care. AIMS: The purpose of this study was to compare OHCA care and outcomes between young patients (<65 years old) and older patients...
December 1, 2017: European Journal of Cardiovascular Nursing
https://www.readbyqxmd.com/read/29197833/prehospital-intravenous-access-for-survival-from-out-of-hospital-cardiac-arrest-propensity-score-matched-analyses-from-a-population-based-cohort-study-in-osaka-japan
#18
Tomoko Fujii, Tetsuhisa Kitamura, Kentaro Kajino, Kosuke Kiyohara, Chika Nishiyama, Tatsuya Nishiuchi, Yasuyuki Hayashi, Takashi Kawamura, Taku Iwami
OBJECTIVES: Prehospital intravenous access is a common intervention for patients with out-of-hospital cardiac arrest (OHCA). We aimed to assess the effectiveness of prehospital intravenous access and subsequent epinephrine administration on outcomes among OHCA patients. METHODS: We conducted a prospective cohort study of patients with OHCA from non-traumatic causes aged ≥18 years in Osaka, Japan from January 2005 through December 2012. The primary outcome was 1-month survival with favourable neurological outcome defined as a cerebral performance category of 1 or 2...
December 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/29173401/public-access-defibrillation-is-this-making-any-difference-controversial-issues-in-resuscitation-from-cardiac-arrest
#19
REVIEW
Myron L Weisfeldt, Ross A Pollack
Public access defibrillation is particularly valuable in witnessed cardiac arrests that occur in public places. Bystander and police use of automated external defibrillators (AEDs) has increased over the past 15 years, resulting in improved survival with normal or near-normal neurologic function. There is great promise for increasing bystander use of defibrillators as the technology is applied to linking patients with shockable arrests to volunteers committed to bringing AEDs to the patients. There continues to be controversy as to the value of epinephrine, antiarrhythmic drugs, hypothermia, and mechanical chest compression in resuscitative efforts...
December 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/29152600/role-of-epinephrine-and-extracorporeal-membrane-oxygenation-in-the-management-of-ischemic-refractory-ventricular-fibrillation-a-randomized-trial-in-pigs
#20
Jason A Bartos, Sebastian Voicu, Timothy R Matsuura, Adamantios Tsangaris, Georgios Sideris, Brett A Oestreich, Stephen A George, Matthew Olson, Kadambari Chandra Shekar, Jennifer N Rees, Kathleen Carlson, Pierre Sebastian, Scott McKnite, Ganesh Raveendran, Tom P Aufderheide, Demetris Yannopoulos
xtracorporeal membrane oxygenation (ECMO) is used in cardiopulmonary resuscitation (CPR) of refractory cardiac arrest. We used a 2×2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF). Pigs underwent 5 minutes of untreated VF, 10 minutes of CPR, and were randomized to receive epinephrine versus placebo for another 35 minutes. Animals were further randomized to LAD reperfusion at minute 45 with ongoing CPR versus veno-arterial ECMO cannulation at minute 45 of CPR and subsequent LAD reperfusion...
June 2017: JACC. Basic to Translational Science
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