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Emergency preservation resuscitation

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https://www.readbyqxmd.com/read/28538639/development-of-the-emergency-preservation-and-resuscitation-for-cardiac-arrest-from-trauma-epr-cat-clinical-trial
#1
Samuel A Tisherman, Hasan B Alam, Peter M Rhee, Thomas M Scalea, Tomas Drabek, Raquel M Forsythe, Patrick M Kochanek McCm
BACKGROUND: Patients who suffer a cardiac arrest from trauma rarely survive, even with aggressive resuscitation attempts, including an Emergency Department (ED) thoracotomy. Emergency Preservation and Resuscitation (EPR) was developed to utilize hypothermia to buy time to obtain hemostasis before irreversible organ damage occurs. Large animal studies have demonstrated that cooling to tympanic membrane temperature 10°C during exsanguination cardiac arrest can allow up to 2 hours of circulatory arrest and repair of simulated injuries with normal neurologic recovery...
May 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28495952/deep-and-profound-hypothermia-in-haemorrhagic-shock-friend-or-foe-a-systematic-review
#2
REVIEW
Samuel E Moffatt, S J B Mitchell, J L Walke
INTRODUCTION: Survival in exsanguinating cardiac arrest patients is poor, as is neurological outcome in survivors. Hypothermia has traditionally been seen as harmful to trauma patients and associated with increased mortality; however, there has been speculation that cooling to very low temperatures (≤20°C) could be used to treat haemorrhagic trauma patients by the induction of a suspended animation period through extreme cooling, which improves survival and preserves neurological function...
May 11, 2017: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/28488551/-emergency-laparotomy-in-a-trauma-patient
#3
F Hietbrink, R K J Simmermacher, M B de Vries, K J P van Wessem, M B de Jong, L P H Leenen
- Emergency laparotomy in trauma patients can be part of the resuscitation process, is based on damage control principles and is therefore fundamentally different from elective laparotomy, for example in case of malignancies. - Indications for emergency laparotomy after trauma are based on haemodynamic instability of the patient and the procedure is focused on restoring the patient's physiological condition.- Haemodynamic and biochemical parameters are used to determine the rest of the strategy. In order to optimize the procedure, the entire treatment team should be practiced in this...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28460803/an-unexpected-presentation-of-sick-sinus-syndrome-isolated-ventricular-asystole
#4
Harun Gunes, Feruza Turan Sonmez, Halit Berk Canga, Ayhan Saritas
Sick sinus syndrome is a disorder of sinus node function characterized by various dysrhythmias such as sinus bradycardia or pause, paroxysmal regular or irregular atrial tachycardia, tachycardiabradycardia attacks or atrial fibrillation with slow ventricular response. Ventricular asystole with preserved atrial electrical activity is a rarely seen presenting rhythm in the ED and an extremely rare cause of syncope. A 67-year-old male having a syncope attack was admitted to the emergency department. His Glasgow coma scale score was 15 on admission...
April 27, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28433359/feasibility-of-profound-hypothermia-as-part-of-extracorporeal-life-support-in-a-pig-model
#5
Christoph Weiser, Wolfgang Weihs, Michael Holzer, Christoph Testori, Anne-Margarethe Kramer, Christoph Kment, Martin Stoiber, Michael Poppe, Christian Wallmüller, Peter Stratil, Michael Hoschitz, Anton Laggner, Fritz Sterz
OBJECTIVE: To investigate the feasibility of a refined aortic flush catheter and pump system to induce emergency preservation and resuscitation before extracorporeal cardiopulmonary resuscitation in a normovolemic cardiac arrest swine model simulating near real size/weight conditions of adults. METHODS: In this feasibility study, 8 female Large White breed pigs weighing 70 to 80 kg underwent ventricular fibrillation cardiac arrest for 15 minutes, followed by 4°C aortic flush (150 mL/kg for the brain; 50 mL/kg for the spine) via a new hardware ensued by resuscitation with extracorporeal cardiopulmonary resuscitation...
March 24, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28430068/caring-for-patients-or-organs-new-therapies-raise-new-dilemmas-in-the-emergency-department
#6
Arjun Prabhu, Lisa S Parker, Michael A DeVita
Two potentially lifesaving protocols, emergency preservation and resuscitation (EPR) and uncontrolled donation after circulatory determination of death (uDCDD), currently implemented in some U.S. emergency departments (EDs), have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to "buy time": one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation...
May 2017: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/28349529/continuous-chest-compression-versus-interrupted-chest-compression-for-cardiopulmonary-resuscitation-of-non-asphyxial-out-of-hospital-cardiac-arrest
#7
REVIEW
Lei Zhan, Li J Yang, Yu Huang, Qing He, Guan J Liu
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Cardiac arrest can be subdivided into asphyxial and non asphyxial etiologies. An asphyxia arrest is caused by lack of oxygen in the blood and occurs in drowning and choking victims and in other circumstances. A non asphyxial arrest is usually a loss of functioning cardiac electrical activity. Cardiopulmonary resuscitation (CPR) is a well-established treatment for cardiac arrest. Conventional CPR includes both chest compressions and 'rescue breathing' such as mouth-to-mouth breathing...
March 27, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28119900/non-puerperal-uterine-inversion-presented-with-hypovolemic-shock
#8
Yong Jung Song, Juseok Yang, Hyun Sil Yun, Sun Kyung Lee, Hwi Gon Kim, Dong Hyung Lee, Ook Hwan Choi, Yong Jin Na
We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status...
December 2016: Journal of Menopausal Medicine
https://www.readbyqxmd.com/read/28103419/family-presence-during-resuscitation-a-double-edged-sword
#9
Hadi Hassankhani, Vahid Zamanzadeh, Azad Rahmani, Hamidreza Haririan, Joanne E Porter
PURPOSE: To illuminate the meaning of the lived experiences of resuscitation team members with the presence of the patient's family during resuscitation in the cultural context of Iran. DESIGN: An interpretative phenomenology was used to discover the lived experiences of the nurses and physicians of Tabriz hospitals, Iran, with family presence during resuscitation (FPDR). A total of 12 nurses and 9 physicians were interviewed over a 6-month period. METHODS: The interviews were audio recorded and semistructured, and were transcribed verbatim...
March 2017: Journal of Nursing Scholarship
https://www.readbyqxmd.com/read/27938903/impact-of-cardiac-arrest-resuscitated-donors-on-heart-transplant-recipients-outcome
#10
Antonella Galeone, Shaida Varnous, Guillaume Lebreton, Eleodoro Barreda, Sara Hariri, Alain Pavie, Pascal Leprince
OBJECTIVE: To evaluate the influence of cardiac arrest-resuscitated donors (CARDs) on the outcome of heart recipients. METHODS: Patients transplanted between July 2004 and December 2012 were divided into 2 groups according to the history of cardiac arrest in donors and their clinical records were retrospectively reviewed. RESULTS: A total of 584 heart transplantations were performed during the study period, and 117 recipients received an organ from a CARD...
March 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27917163/severely-heat-injured-survivors-of-e-coli-o157-h7-atcc-43888-display-variable-and-heterogeneous-stress-resistance-behavior
#11
Elisa Gayán, Sander K Govers, Chris W Michiels, Abram Aertsen
Although minimal food processing strategies aim to eliminate foodborne pathogens and spoilage microorganisms through a combination of mild preservation techniques, little is actually known on the resistance behavior of the small fraction of microorganisms surviving an inimical treatment. In this study, the conduct of severely heat stressed survivors of E. coli O157:H7 ATCC 43888, as an indicator for the low infectious dose foodborne enterohemorrhagic strains, was examined throughout their resuscitation and outgrowth...
2016: Frontiers in Microbiology
https://www.readbyqxmd.com/read/27608941/the-introduction-of-emergency-cricothyroidotomy-simulation-training-in-zimbabwe-contributed-to-the-saving-of-two-lives
#12
M B Avnstorp, P V F Jensen, T Dzongodza, N Matinhira, C Chidziva, J Melchiors, C Von Buchwald
BACKGROUND: In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS: A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest...
October 2016: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/27533415/in-hospital-resuscitation-recognising-and-responding-to-adults-in-cardiac-arrest
#13
Elizabeth Simpson
Survival rates following in-hospital cardiac arrest remain low. The majority of patients who survive a cardiac arrest will be in a monitored environment, have a witnessed cardiac arrest and present with a shockable rhythm, usually ventricular fibrillation. Nurses have a responsibility to preserve safety, which requires the ability to accurately assess patients for signs of deterioration in physical health, and to provide assistance when an emergency arises in practice. Nurses must work within the limits of their competence and be able to establish the urgency of a situation...
August 17, 2016: Nursing Standard
https://www.readbyqxmd.com/read/27136246/experience-with-a-new-process-condition-t-for-uncontrolled-donation-after-circulatory-determination-of-death-in-a-university-emergency-department
#14
Michael A DeVita, Clifton W Callaway, Charissa Pacella, Maria Mori Brooks, John Lutz, Susan Stuart
BACKGROUND: In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD). METHODS: A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers...
March 2016: Progress in Transplantation
https://www.readbyqxmd.com/read/27025140/-volemic-status-and-the-phasic-approach-to-the-treatment-of-critical-states-new-opportunites-and-prospects
#15
REVIEW
V V Kuz'kov, E V Fot, A A Smjotkin, K M Lebedinskij, M Yu Kirov
Current guidelines suggest that an early and aggressive fluid therapy is the best rescue approach to restore and preserve cardiac index, organ function and decrease the risk of multiple organ failure in shock of various origin. However, escala- tion of fluid resuscitation is a double-edged sword often associated with reperfusion, glicocalyx injury, capillary leakage, delayed weight gain and heperhydration. The body of evidences demons trates that an excessive fluid load in ICUpatient with global increased permeability syndrome, and, particularly, in ARDS and acute kidney injury can be devastating, particularly when guided with central venous pressure...
November 2015: Anesteziologiia i Reanimatologiia
https://www.readbyqxmd.com/read/27022814/isolated-fournier-s-gangrene-of-the-penis
#16
A O Obi
To share experience on the presentation and management of 4 cases of isolated penile Fournier's gangrene. Clinical and demographic data of four patients with isolated penile Fournier's gangrene seen over an 8-year period (January 2006-December 2013) were reviewed. All patients had intravenous fluid resuscitation, emergency surgical debridement, and broad-spectrum intravenous antibiotics. Fournier's gangrene of the penis was, respectively, due to long segment anterior urethral stricture, penile edema from poorly controlled congestive cardiac failure, penile abrasion from oral sex and idiopathic...
May 2016: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/26946212/past-present-and-future-of-dynamic-kidney-and-liver-preservation-and-resuscitation
#17
I Jochmans, M Z Akhtar, D Nasralla, P Kocabayoglu, C Boffa, M Kaisar, A Brat, J O'Callaghan, L H M Pengel, S Knight, R J Ploeg
The increased demand for organs has led to the increased usage of "higher risk" kidney and liver grafts. These grafts from donation after circulatory death or expanded criteria donors are more susceptible to preservation injury and have a higher risk of unfavorable outcomes. Dynamic, instead of static, preservation could allow for organ optimization, offering a platform for viability assessment, active organ repair and resuscitation. Ex situ machine perfusion and in situ regional perfusion in the donor are emerging as potential tools to preserve and resuscitate vulnerable grafts...
September 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/26644358/emergency-preservation-and-resuscitation-trial-a-philosophical-justification-for-non-voluntary-enrollment
#18
Daniel Tigard
In a current clinical trial for Emergency Preservation and Resuscitation (EPR), Dr. Samuel Tisherman of the University of Maryland aims to induce therapeutic hypothermia in order to 'buy time' for operating on victims of severe exsanguination. While recent publicity has framed this controversial procedure as 'killing a patient to save his life', the US Army and Acute Care Research appear to support the study on the grounds that such patients already face low chances of survival. Given that enrollment in the trial must be non-voluntary, the study has received an exemption from federal standards for obtaining informed consent...
June 2016: Bioethics
https://www.readbyqxmd.com/read/26626335/lesson-from-the-new-york-city-out-of-hospital-uncontrolled-donation-after-circulatory-determination-of-death-program
#19
Stephen P Wall, Bradley J Kaufman, Nicholas Williams, Elizabeth M Norman, Alexander J Gilbert, Kevin G Munjal, Shana Maikhor, Michael J Goldstein, Julia E Rivera, Harvey Lerner, Chad Meyers, Marion Machado, Susan Montella, Marcy Pressman, Lewis W Teperman, Nancy N Dubler, Lewis R Goldfrank
STUDY OBJECTIVE: In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. METHODS: We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011...
April 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26603283/successful-transplantation-of-lungs-from-an-uncontrolled-donor-after-circulatory-death-preserved-in-situ-by-alveolar-recruitment-maneuvers-and-assessed-by-ex-vivo-lung-perfusion
#20
F Valenza, G Citerio, A Palleschi, A Vargiolu, B Safaee Fakhr, A Confalonieri, M Nosotti, S Gatti, S Ravasi, S Vesconi, A Pesenti, F Blasi, L Santambrogio, L Gattinoni
We developed a protocol to procure lungs from uncontrolled donors after circulatory determination of death (NCT02061462). Subjects with cardiovascular collapse, treated on scene by a resuscitation team and transferred to the emergency room, are considered potential donors once declared dead. Exclusion criteria include unwitnessed collapse, no-flow period of >15 min and low flow >60 min. After death, lung preservation with recruitment maneuvers, continuous positive airway pressure, and protective mechanical ventilation is applied to the donor...
April 2016: American Journal of Transplantation
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