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post cardiac arrest sedation

Joshua Pound, P Richard Verbeek, Sheldon Cheskes
BACKGROUND: High quality cardiopulmonary resuscitation (CPR) has produced a relatively new phenomenon of consciousness in patients with vital signs absent. Further research is necessary to produce a viable treatment strategy during and post resuscitation. OBJECTIVE: To provide a case study done by paramedics in the field illustrating the need for sedation in a patient whose presentation was consistent with CPR induced consciousness. Resuscitative challenges are provided as well as potential future treatment options to minimize harm to both patients and prehospital providers...
October 28, 2016: Prehospital Emergency Care
Edilberto Amorim, Jon C Rittenberger, Julia J Zheng, M Brandon Westover, Maria E Baldwin, Clifton W Callaway, Alexandra Popescu
OBJECTIVE: Hypoxic brain injury is the largest contributor to disability and mortality after cardiac arrest. We aim to identify electroencephalogram (EEG) characteristics that can predict outcome on cardiac arrest patients treated with targeted temperature management (TTM). METHODS: We retrospectively examined clinical, EEG, functional outcome at discharge, and in-hospital mortality for 373 adult subjects with return of spontaneous circulation after cardiac arrest...
December 2016: Resuscitation
Christine M Murphy, Cliff Williams, Michael E Quinn, Brian Nicholson, Thomas Shoe, Michael C Beuhler, William P Kerns
Animal studies and human case reports show promise in using lipid rescue to treat refractory calcium channel antagonist toxicity. However, the majority of research and clinical experience has focused on non-dihydropyridine agents. Thus, we sought to investigate the value of lipid emulsion (ILE) therapy for dihydropyridine-induced shock. This IACUC-approved study utilized seven swine that were sedated with alpha-chloralose, mechanically ventilated, and instrumented for drug delivery and hemodynamic measures...
August 8, 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
Patrick J Coppler, Kelly N Sawyer, Chun Song Youn, Seung Pill Choi, Kyu Nam Park, Young-Min Kim, Joshua C Reynolds, David F Gaieski, Byung Kook Lee, Joo Suk Oh, Won Young Kim, Hyung Jun Moon, Benjamin S Abella, Jonathan Elmer, Clifton W Callaway, Jon C Rittenberger
There is little consensus regarding many post-cardiac arrest care parameters. Variability in such practices could confound the results and generalizability of post-arrest care research. We sought to characterize the variability in post-cardiac arrest care practice in Korea and the United States. A 54-question survey was sent to investigators participating in one of two research groups in South Korea (Korean Hypothermia Network [KORHN]) and the United States (National Post-Arrest Research Consortium [NPARC])...
July 15, 2016: Therapeutic Hypothermia and Temperature Management
Marine Paul, Wulfran Bougouin, Guillaume Geri, Florence Dumas, Benoit Champigneulle, Stéphane Legriel, Julien Charpentier, Jean-Paul Mira, Claudio Sandroni, Alain Cariou
PURPOSE: Although prolonged unconsciousness after cardiac arrest (CA) is a sign of poor neurological outcome, limited evidence shows that a late recovery may occur in a minority of patients. We investigated the prevalence and the predictive factors of delayed awakening in comatose CA survivors treated with targeted temperature management (TTM). METHODS: Retrospective analysis of the Parisian Region Out-of-Hospital CA Registry (2008-2013). In adult comatose CA survivors treated with TTM, sedated with midazolam and fentanyl, time to awakening was measured starting from discontinuation of sedation at the end of rewarming...
July 2016: Intensive Care Medicine
Michael S Merrill, Catherine M Wares, Alan C Heffner, Kenneth L Shauger, H James Norton, Michael S Runyon, David A Pearson
BACKGROUND: Recent advances in post-cardiac arrest (CA) care including therapeutic hypothermia (TH) have improved survival and favorable neurologic outcomes for survivors of CA. Survivors often present with deep coma and lack of brainstem reflexes, which are generally associated with adverse outcomes in many disease processes. Little is known regarding the role of initial emergency department (ED) neurological examination and its potential for prognostication. OBJECTIVES: The purpose of this study is to determine if components of a standardized neurologic examination are reliable prognosticators in patients recently resuscitated from CA...
June 2016: American Journal of Emergency Medicine
Delphine Heimburger, Michel Durand, Lucie Gaide-Chevronnay, Geraldine Dessertaine, Pierre-Henri Moury, Pierre Bouzat, Pierre Albaladejo, Jean-Francois Payen
BACKGROUND: Predicting outcome after cardiac arrest (CA) is particularly difficult when therapeutic hypothermia (TH) is used. We investigated the performance of quantitative pupillometry and transcranial Doppler (TCD) in this context. METHODS: This prospective observational study included 82 post-CA patients. Quantitative assessment of pupillary light reflex (PLR) and TCD measurements of the two middle cerebral arteries were performed at admission (day 1) and after 24h (day 2) during TH (33-35°C) and sedation...
June 2016: Resuscitation
Cecilia Lucía Balaban, Joaquín Valentín Rodríguez, Claudio Tiribelli, Edgardo Elvio Guibert
Liver transplantation is currently the preferred treatment option for end-stage liver disease. Donation after cardiac death was a common practice in the early years of organ donation before brain death criteria were established. Those organs were subjected to variable periods of warm ischemia that might intensify cold ischemia/reperfusion injuries. In the present, shortage of brain dead donors has led to the reassessment of organ donation after cardiac death. Since many cytoprotective roles have been describe for H2S during ischemia/reperfusion on a variety of tissues, we hypothesized that graft exposure to this bioactive gas might improve preservation of non-heart beating donated organs...
August 2015: Cryobiology
Bhooma R Aravamuthan, Michael Shoykhet
BACKGROUND: The basal ganglia are vulnerable to injury during cardiac arrest. Movement disorders are a common morbidity in survivors. Yet, neuronal motor network changes post-arrest remain poorly understood. METHODS: We compared function of the motor network in adult rats that, during postnatal week 3, underwent 9.5 min of asphyxial cardiac arrest (n = 9) or sham intervention (n = 8). Six months after injury, we simultaneously recorded local field potentials (LFP) from the primary motor cortex (MCx) and single neuron firing and LFP from the rat entopeduncular nucleus (EPN), which corresponds to the primate globus pallidus pars interna...
October 2015: Pediatric Research
Ya-Jie Zhang, Meng-Jun Wu, Yi Li, Hai Yu
Although improvement in cardiopulmonary resuscitation (CPR) performance and the increasing success at achieving return of spontaneous circulation (ROSC) have been possible in recent years, the survival and discharge rates of post-cardiac arrest (CA) patients remain disappointing. The high mortality rate is attributed to whole-body ischemia/reperfusion (I/R) induced multi-organ dysfunction that is well known as post-cardiac arrest syndrome. Post-cardiac arrest myocardial dysfunction and brain injury are the main clinical features of this complex pathophysiological process...
January 2015: Medical Hypotheses
Nawfel Ben-Hamouda, Fabio S Taccone, Andrea O Rossetti, Mauro Oddo
Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis...
November 2014: Chest
Gilson Soares Feitosa-Filho, Joberto Pinheiro Sena, Hélio Penna Guimarães, Renato Delascio Lopes
Cardiac arrest survivors frequently suffer from ischemic brain injury associated with poor neurological outcome and death. Therapeutic hypothermia improves outcomes in comatose survivors after resuscitation from out-of-hospital cardiac arrest. Considering its formal recommendation as a therapy, post-return of spontaneous circulation after cardiac arrest, the objective of this study was to review the clinical aspects of therapeutic hypothermia. Non-systematic review of articles using the keywords "cardiac arrest, cardiopulmonary resuscitation, cooling, hypothermia, post resuscitation syndrome" in the Med-Line database was performed...
March 2009: Revista Brasileira de Terapia Intensiva
Erik Westhall, Ingmar Rosén, Andrea O Rossetti, Anne-Fleur van Rootselaar, Troels Wesenberg Kjaer, Janneke Horn, Susann Ullén, Hans Friberg, Niklas Nielsen, Tobias Cronberg
BACKGROUND: Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. METHODS/DESIGN: In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG...
2014: BMC Neurology
N Shaikh, M F Malmstrom
UNLABELLED: Therapeutic hypothermia (protective hypothermia) has been known to have beneficial effects since ancient times but interest was renewed after two land mark publication a decade ago. The survival as well as quality of life of post cardiac arrest patients depends on neurological outcome. Mild induced hypothermia is recommended for improving the neurological status of these patients. All acute care physician, nurses and emergency medical services personals should be aware of this approach...
2012: Qatar Medical Journal
Tamarah Suys, Pierre Bouzat, Pedro Marques-Vidal, Nathalie Sala, Jean-François Payen, Andrea O Rossetti, Mauro Oddo
BACKGROUND: Sedation and therapeutic hypothermia (TH) delay neurological responses and might reduce the accuracy of clinical examination to predict outcome after cardiac arrest (CA). We examined the accuracy of quantitative pupillary light reactivity (PLR), using an automated infrared pupillometry, to predict outcome of post-CA coma in comparison to standard PLR, EEG, and somato-sensory evoked potentials (SSEP). METHODS: We prospectively studied over a 1-year period (June 2012-June 2013) 50 consecutive comatose CA patients treated with TH (33 °C, 24 h)...
October 2014: Neurocritical Care
M Ezzati, K Broad, G Kawano, S Faulkner, J Hassell, B Fleiss, P Gressens, I Fierens, J Rostami, M Maze, J W Sleigh, B Anderson, R D Sanders, N J Robertson
BACKGROUND: The highly selective α2 -adrenoreceptor agonist, dexmedetomidine, exerts neuroprotective, analgesic, anti-inflammatory and sympatholytic properties that may be beneficial for perinatal asphyxia. The optimal safe dose for pre-clinical newborn neuroprotection studies is unknown. METHODS: Following cerebral hypoxia-ischaemia, dexmedetomidine was administered to nine newborn piglets in a de-escalation dose study in combination with hypothermia (whole body cooling to 33...
July 2014: Acta Anaesthesiologica Scandinavica
Fabio Taccone, Tobias Cronberg, Hans Friberg, David Greer, Janneke Horn, Mauro Oddo, Sabino Scolletta, Jean-Louis Vincent
The prognosis of patients who are admitted in a comatose state following successful resuscitation after cardiac arrest remains uncertain. Although the introduction of therapeutic hypothermia (TH) and improvements in post-resuscitation care have significantly increased the number of patients who are discharged home with minimal brain damage, short-term assessment of neurological outcome remains a challenge. The need for early and accurate prognostic predictors is crucial, especially since sedation and TH may alter the neurological examination and delay the recovery of motor response for several days...
January 14, 2014: Critical Care: the Official Journal of the Critical Care Forum
Hans Friberg, Erik Westhall, Ingmar Rosén, Malin Rundgren, Niklas Nielsen, Tobias Cronberg
There has been a dramatic change in hospital care of cardiac arrest survivors in recent years, including the use of target temperature management (hypothermia). Clinical signs of recovery or deterioration, which previously could be observed, are now concealed by sedation, analgesia, and muscle paralysis. Seizures are common after cardiac arrest, but few centers can offer high-quality electroencephalography (EEG) monitoring around the clock. This is due primarily to its complexity and lack of resources but also to uncertainty regarding the clinical value of monitoring EEG and of treating post-ischemic electrographic seizures...
2013: Critical Care: the Official Journal of the Critical Care Forum
Audrey de Jong, Nicolas Molinari, Sylvie de Lattre, Claudine Gniadek, Julie Carr, Mathieu Conseil, Marie-Pierre Susbielles, Boris Jung, Samir Jaber, Gérald Chanques
INTRODUCTION: A quality-improvement project was conducted to reduce severe pain and stress-related events while moving ICU-patients. METHODS: The Plan-Do-Check-Adjust cycle was studied during four one-month phases, separated by five-month interphases. All consecutive patients staying more than 24 hours were evaluated every morning while being moved for nursing care (bathing, massage, sheet-change, repositioning). Phase 1 was considered as the baseline. Implemented and adjusted quality-interventions were assessed at phases 2 and 3, respectively...
2013: Critical Care: the Official Journal of the Critical Care Forum
Jemeen Sreedharan, Elizabeth Gourlay, Matthew R Evans, Michalis Koutroumanidis
BACKGROUND: Prognostication following anoxic coma relies on clinical assessment and is assisted by neurophysiology. A non-evolving EEG spike burst/isoelectric suppression pattern after the first 24 hours almost invariably indicates poor outcome, while an evolving pattern implies nonconvulsive status epilepticus (NCSE) that may "hide" surviving brain activity and is amenable to treatment. CASE STUDY: We present the case of a 53-year-old woman who had a witnessed out-of-hospital ventricular fibrillation cardiac arrest, was resuscitated by paramedics, but remained comatose...
September 2012: Epileptic Disorders: International Epilepsy Journal with Videotape
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