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https://www.readbyqxmd.com/read/28215591/the-effect-of-resuscitation-position-on-cerebral-and-coronary-perfusion-pressure-during-mechanical-cardiopulmonary-resuscitation-in-porcine-cardiac-arrest-model
#1
Taeyun Kim, Sang Do Shin, Kyoung Jun Song, Yong Joo Park, Hyun Ho Ryu, Guillaume Debaty, Keith Lurie, Ki Jeong Hong
OBJECTIVE: Automated cardiopulmonary resuscitation (CPR) devices can be used during transport in a small spaces (e.g. an elevator) to reduce the length of stretcher and via body position change. It is unknown whether patient position is associated with the optimal cerebral (CePP) and coronary (CoPP) perfusion pressure. METHODS: This study utilized a randomized experimental design and anesthetized, intubated and paralyzed female pigs (n=12) (mean 42, SD 3kg) on a customized tilt table...
February 16, 2017: Resuscitation
https://www.readbyqxmd.com/read/28215590/does-an-individualized-feedback-mechanism-improve-quality-of-out-of-hospital-cpr
#2
B Weston, J Jasti, E B Lerner, A Szabo, T Aufderheide, M R Colella
BACKGROUND: Despite its prevalence, survival from out-of-hospital cardiac arrest remains low. Early defibrillation, greater compression fraction, optimal compression rate, sufficient compression depth, and shorter pre-shock pause have been associated with improved survival in cardiac arrest patients. In early 2014, a program was initiated to provide feedback on CPR quality to prehospital providers after every treated cardiac arrest. OBJECTIVE: To assess whether individualized CPR feedback was associated with improved CPR quality measures in the prehospital setting...
February 16, 2017: Resuscitation
https://www.readbyqxmd.com/read/28209484/successful-provision-of-inter-hospital-extracorporeal-cardiopulmonary-resuscitation-for-acute-post-partum-pulmonary-embolism
#3
C McDonald, J Laurie, S Janssens, C Zazulak, P Kotze, K Shekar
Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived...
January 9, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28187154/comparison-of-different-inspiratory-triggering-settings-in-automated-ventilators-during-cardiopulmonary-resuscitation-in-a-porcine-model
#4
Dingyu Tan, Jun Xu, Shihuan Shao, Yangyang Fu, Feng Sun, Yazhi Zhang, Yingying Hu, Joseph Walline, Huadong Zhu, Xuezhong Yu
BACKGROUND: Mechanical ventilation via automated in-hospital ventilators is quite common during cardiopulmonary resuscitation. It is not known whether different inspiratory triggering sensitivity settings of ordinary ventilators have different effects on actual ventilation, gas exchange and hemodynamics during resuscitation. METHODS: 18 pigs enrolled in this study were anaesthetized and intubated. Continuous chest compressions and mechanical ventilation (volume-controlled mode, 100% O2, respiratory rate 10/min, and tidal volumes 10ml/kg) were performed after 3 minutes of ventricular fibrillation...
2017: PloS One
https://www.readbyqxmd.com/read/28176385/financial-and-clinical-outcomes-of-extracorporeal-mechanical-support
#5
Ryan Chiu, Eric Pillado, Sohail Sareh, Kim De La Cruz, Richard J Shemin, Peyman Benharash
BACKGROUND: Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period. METHODS: A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150)...
February 8, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28168185/optimal-chest-compression-rate-and-compression-to-ventilation-ratio-in-delivery-room-resuscitation-evidence-from-newborn-piglets-and-neonatal-manikins
#6
REVIEW
Anne Lee Solevåg, Georg M Schmölzer
Cardiopulmonary resuscitation (CPR) duration until return of spontaneous circulation (ROSC) influences survival and neurologic outcomes after delivery room (DR) CPR. High quality chest compressions (CC) improve cerebral and myocardial perfusion. Improved myocardial perfusion increases the likelihood of a faster ROSC. Thus, optimizing CC quality may improve outcomes both by preserving cerebral blood flow during CPR and by reducing the recovery time. CC quality is determined by rate, CC to ventilation (C:V) ratio, and applied force, which are influenced by the CC provider...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28168038/echocardiography-for-patients-undergoing-extracorporeal-cardiopulmonary-resuscitation-a-primer-for-intensive-care-physicians
#7
REVIEW
Zhongheng Zhang
Echocardiography is an invaluable tool in the management of patients with extracorporeal cardiopulmonary resuscitation (ECPR) and subsequent extracorporeal membrane oxygenation (ECMO) support and weaning. At the very beginning, echocardiography can identify the etiology of cardiac arrest, such as massive pulmonary embolism and cardiac tamponade. Eliminating these culprits saves life and may avoid the initiation of extracorporeal cardiopulmonary resuscitation. If the underlying causes are not identified or intrinsic to the heart (e...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/28152998/critical-appraisal-of-advance-directives-given-by-patients-with-fatal-acute-stroke-an-observational-cohort-study
#8
A Alonso, D Dörr, K Szabo
BACKGROUND: Advance directives (AD) imply the promise of determining future medical treatment in case of decisional incapacity. However, clinical practice increasingly indicates that standardized ADs often fail to support patients' autonomy. To date, little data are available about the quality and impact of ADs on end-of-life decisions for incapacitated acute stroke patients. METHODS: We analyzed the ADs of patients with fatal stroke, focusing on: (a) their availability and type, (b) stated circumstances to which the AD should apply, and (c) stated wishes regarding specific treatment options...
February 2, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28148274/severity-dependent-differences-in-early-management-of-thoracic-trauma-in-severely-injured-patients%C3%A2-analysis-based-on-the-traumaregister-dgu%C3%A2
#9
J Bayer, R Lefering, S Reinhardt, J Kühle, N P Südkamp, T Hammer
BACKGROUND: Major trauma is associated with chest injuries in nearly 50% of multiple injuries. Thoracic trauma is a relevant source of comorbidity throughout the period of multiply-injured patient care and may require swift and well-thought-out interventions in order to avert a deleterious outcome. In this epidemiological study we seek to characterize groups of different thoracic trauma severity in severely injured patients and identify related differences in prehospital and early clinical management...
February 2, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28147231/syncope-outcomes-and-conditions-associated-with-hospitalization
#10
Parijat Saurav Joy, Gagan Kumar, Brian Olshansky
PURPOSE: Syncope is a perplexing problem for which hospital admission and readmission are contemplated but outcomes remain uncertain. Our purpose was to determine the incidence of admissions and readmissions for syncope and compare associated conditions, in-hospital outcomes and resource utilization. METHODS: The 2005-2011 California Statewide Inpatient Database was utilized. Patients of age ≥18 admitted under ICD-9-CM code 780.2 ("syncope or collapse") were selected...
January 29, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28126283/fenton-process-on-single-and-mixture-components-of-phenothiazine-pharmaceuticals-assessment-of-intermediaries-fate-and-preliminary-ecotoxicity
#11
Marcelo L Wilde, Mandy Schneider, Klaus Kümmerer
Pharmaceuticals do not occur isolated in the environment but in multi-component mixtures and may exhibit antagonist, synergistic or additive behavior. Knowledge on this is still scarce. The situation is even more complicated if effluents or potable water is treated by oxidative processes or such transformations occur in the environment. Thus, determining the fate and effects of parent compounds, metabolites and transformation products (TPs) formed by transformation and degradation processes in the environment is needed...
January 23, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/28108254/changes-in-pitch-height-elicit-both-language-universal-and-language-dependent-changes-in-neural-representation-of-pitch-in-the-brainstem-and-auditory-cortex
#12
Ananthanarayan Krishnan, Chandan H Suresh, Jackson T Gandour
Language experience shapes encoding of pitch-relevant information at both brainstem and cortical levels of processing. Pitch height is a salient dimension that orders pitch from low to high. Herein we investigate the effects of language experience (Chinese, English) in the brainstem and cortex on (i) neural responses to variations in pitch height, (ii) presence of asymmetry in cortical pitch representation, and (iii) patterns of relative changes in magnitude of pitch height between these two levels of brain structure...
January 17, 2017: Neuroscience
https://www.readbyqxmd.com/read/28103421/structure-of-the-arabidopsis-thaliana-nadph-cytochrome-p450-reductase-2-atr2-provides-insight-into-its-function
#13
Guoqi Niu, Shun Zhao, Lei Wang, Wei Dong, Lin Liu, Yikun He
: Members of the cytochrome P450 family catalyze a variety of mono-oxygenase reactions, and for the eukaryotic membrane-bound members, NADPH is typically used as the reducing agent. The flavoprotein NADPH-cytochrome P450 reductase (CPR) enables electron transfer from NADPH to cytochrome P450 via its flavin cofactors. ATR2 is one of the two authentic CPR genes in the genome of the model plant Arabidopsis thaliana, and its product has been physiologically and kinetically characterized. Here, we report the 2...
January 19, 2017: FEBS Journal
https://www.readbyqxmd.com/read/28099693/factors-associated-with-maternal-mortality-among-patients-meeting-criteria-of-severe-maternal-morbidity-and-near-miss
#14
Hesly M P Lima, Francisco Herlânio C Carvalho, Francisco Edson L Feitosa, George C Nunes
OBJECTIVE: To evaluate factors associated with maternal death among women experiencing life-threatening conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. METHODS: A secondary analysis of data prospectively collected in a Brazilian multicenter cross-sectional study between July 2009 and June 2010 was conducted. Women were identified who delivered at a hospital in Ceará and who had potentially life-threatening conditions. Stepwise logistic regression was used to identify factors associated with maternal death...
March 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28097649/hospital-variation-in-utilization-of-life-sustaining-treatments-among-patients-with-do-not-resuscitate-orders
#15
Allan J Walkey, Janice Weinberg, Renda Soylemez Wiener, Colin R Cooke, Peter K Lindenauer
OBJECTIVE: To determine between-hospital variation in interventions provided to patients with do not resuscitate (DNR) orders. DATA SOURCES/SETTING: United States Agency of Healthcare Research and Quality, Healthcare Cost and Utilization Project, California State Inpatient Database. STUDY DESIGN: Retrospective cohort study including hospitalized patients aged 40 and older with potential indications for invasive treatments: in-hospital cardiac arrest (indication for CPR), acute respiratory failure (mechanical ventilation), acute renal failure (hemodialysis), septic shock (central venous catheterization), and palliative care...
January 18, 2017: Health Services Research
https://www.readbyqxmd.com/read/28092783/pulmonary-emboli-cardiac-arrest-with-cpr-complication-liver-laceration-and-massive-abdominal-bleed-a-case-report
#16
John Lundqvist, Jan G Jakobsson
INTRODUCTION: Massive pulmonary emboli may cause right ventricular failure and backward stasis with parenchymal organ swelling thus increasing the risk for laceration, e.g. if CPR is needed. PRESENTATION OF CASE: A 28-year-old Colombian female with no medical history but taking contraceptive pills and having had a recent longer flight was admitted to Danderyds hospital Emergency Department because of respiratory failure. She developed cardiac arrest in the emergence department following the emergent diagnosis of pulmonary emboli...
January 3, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28078859/role-of-vitacamphore-in-improving-central-pro-inflammatory-cytokines-following-transient-global-ischemia
#17
J Lin, L Pang, X L Liu, J Xing
Pro-inflammatory cytokines (PICs) including interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) are responsive to ischemic stress. This process thereby modulates the responsiveness of many cell types under diseased conditions. The current study was to examine the role played by vitacamphore (VCP) in regulating the levels of PICs and protein expression of PIC receptors in the cerebral cortex and hippocampus of rats after cardiac arrest (CA)-induced transient global ischemia. CA was induced by asphyxia followed by cardiopulmonary resuscitation (CPR) in rats...
October 2016: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28074587/after-the-dnr-surrogates-who-persist-in-requesting-cardiopulmonary-resuscitation
#18
Ellen M Robinson, Wendy Cadge, Angelika A Zollfrank, M Cornelia Cremens, Andrew M Courtwright
Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a set of clearly defined procedures for these decisions...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28074576/decisions-and-authority
#19
Gregory E Kaebnick
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28073853/resuscitation-of-prolonged-cardiac-arrest-from-massive-pulmonary-embolism-by-extracorporeal-membrane-oxygenation
#20
Yun Seok Kim, Wookjin Choi, Jaecheol Hwang
Extracorporeal cardiopulmonary resuscitation can be used as a rescue strategy in cases of prolonged cardiac arrest caused by massive pulmonary embolism. We present a case of a male patient who was in prolonged cardiac arrest following massive pulmonary embolism. Veno-arterial extracorporeal membrane oxygenation was initiated approximately 93 min after prolonged cardiopulmonary resuscitation. After resuscitation, bedside echocardiography and a chest computed tomography angiogram revealed a massive pulmonary embolism during extracorporeal membrane oxygenation support...
January 10, 2017: European Journal of Cardio-thoracic Surgery
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