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Return of spontaneous circulation

Christian Hassager, Ken Nagao, David Hildick-Smith
The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. In most patients, the most important in-hospital interventions other than routine intensive care are continuous active treatment (in non-comatose and comatose patients and including circulatory support in selected patients), cooling of core temperature to 32-36°C by targeted temperature management for at least 24 h, immediate coronary angiography with or without percutaneous coronary intervention, and delay of final prognosis until at least 72 h after OHCA...
March 10, 2018: Lancet
Marcus Eng Hock Ong, Gavin D Perkins, Alain Cariou
Sudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services' staff...
March 10, 2018: Lancet
Thomas Uray, Andrew Lamade, Jonathan Elmer, Tomas Drabek, Jason P Stezoski, Amalea Missé, Keri Janesko-Feldman, Robert H Garman, Niel Chen, Patrick M Kochanek, Cameron Dezfulian
OBJECTIVES: Cardiac arrest etiology may be an important source of between-patient heterogeneity, but the impact of etiology on organ injury is unknown. We tested the hypothesis that asphyxial cardiac arrest results in greater neurologic injury than cardiac etiology cardiac arrest (ventricular fibrillation cardiac arrest), whereas ventricular fibrillation cardiac arrest results in greater cardiovascular dysfunction after return of spontaneous circulation. DESIGN: Prospective observational human and randomized animal study...
March 10, 2018: Critical Care Medicine
Yong Soo Cho, Byung Kook Lee, Dong Hun Lee, Yong Hun Jung, Sung Min Lee, Jung Soo Park, Kyung Woon Jeung
PURPOSE: The optimal timing for measurement of neutrophil gelatinase-associated lipocalin (NGAL) level to predict acute kidney injury (AKI) and prognosis in cardiac arrest (CA) survivors has not been elucidated. We aimed to compare the diagnostic and prognostic performance of NGAL levels after return of spontaneous circulation (ROSC) and at 48 h after CA. METHODS: We included 231 adult cardiac arrest survivors who underwent targeted temperature management between May 2013 and December 2016...
March 13, 2018: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
Wolfgang Muhlhofer, Jerzy P Szaflarski
PURPOSE OF REVIEW: This paper aims to review and summarize the key contributions of EEG to prognostication after cardiac arrest (CA). RECENT FINDINGS: While there are more EEG patterns predicting poor than good outcome, even EEG patterns previously considered to be "very malignant" may result in survival with a meaningful neurological outcome depending on their underlying etiology as well as the continuity and reactivity of the EEG background. Regardless of the potentially confounding factors, EEG patterns are highly specific with a relatively low false-positive rate...
March 10, 2018: Current Neurology and Neuroscience Reports
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
Rong Liu, Xiaoxing Liao, Xin Li, Hongyan Wei, Qing Liang, Zuopeng Zhang, Meixian Yin, Xiaoyun Zeng, Zijing Liang, Chunlin Hu
To investigate long noncoding (lnc)-RNA and mRNA expression profiles in post‑cardiac arrest (CA) brains, an external transthoracic electrical current was applied for 8 min to induce CA (the CA group). A total of 4 rats received sham-operations and served as the blank control (BC) group. Upon return of spontaneous circulation (ROSC), lncRNA and mRNA expression in the rat cerebral cortex was assayed with high‑throughput Agilent lncRNA and mRNA microarrays. In total, 37 lncRNAs were upregulated and 21 lncRNAs were downregulated in the CA group, and 258 mRNA transcripts were differentially expressed with 177 mRNAs upregulated and 81 mRNAs downregulated in the CA group...
March 7, 2018: Molecular Medicine Reports
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
Tomas Barry, Mary Headon, Ronan Glynn, Niall Conroy, Helen Tobin, Mairead Egan, Gerard Bury
AIM: The aim of this study is to establish the role and outcome of general practitioner (GP) involvement in out of hospital cardiac arrest (OHCA) resuscitation in the Republic of Ireland. METHODS: A ten year prospective observational study involving a cohort of Irish general practices. SETTING: 521 general practice settings distributed throughout the Republic of Ireland, representing approximately one quarter of all practices and a third of Irish GPs...
March 3, 2018: Resuscitation
Maria Skytioti, Signe Søvik, Maja Elstad
Spontaneous breathing has beneficial effects on the circulation, since negative intrathoracic pressure enhances venous return and increases cardiac stroke volume. We quantified the contribution of the respiratory pump to preserve stroke volume during hypovolemia in awake, young, healthy subjects. Non-invasive stroke volume, cardiac output, heart rate and mean arterial pressure (Finometer) were recorded in 31 volunteers (19 females), 19-30 years old, during normovolemia and hypovolemia (approximating 450-500 ml reduction in central blood volume) induced by lower body negative pressure...
March 1, 2018: Journal of Applied Physiology
Kaibin Huang, Ziyue Wang, Yong Gu, Zhong Ji, Zhenzhou Lin, Shengnan Wang, Suyue Pan, Yongming Wu
BACKGROUND: Glibenclamide (GBC) improves neurological outcome after cardiac arrest (CA) in rats. In this study, we sought to elucidate the mechanism responsible for the neuroprotective effects of GBC by using a high-field MRI system. METHODS: Male Sprague-Dawley rats were subjected to 10-min asphyxial CA followed by cardiopulmonary resuscitation (CPR). Diffusion-weighted imaging (DWI) as well as conventional T2-weighted imaging was conducted prior to CA and at 24, 48, and 72 h after resuscitation...
February 28, 2018: Neurocritical Care
Patricia Jabre, Andrea Penaloza, David Pinero, Francois-Xavier Duchateau, Stephen W Borron, Francois Javaudin, Olivier Richard, Diane de Longueville, Guillem Bouilleau, Marie-Laure Devaud, Matthieu Heidet, Caroline Lejeune, Sophie Fauroux, Jean-Luc Greingor, Alessandro Manara, Jean-Christophe Hubert, Bertrand Guihard, Olivier Vermylen, Pascale Lievens, Yannick Auffret, Celine Maisondieu, Stephanie Huet, Benoît Claessens, Frederic Lapostolle, Nicolas Javaud, Paul-Georges Reuter, Elinor Baker, Eric Vicaut, Frédéric Adnet
Importance: Bag-mask ventilation (BMV) is a less complex technique than endotracheal intubation (ETI) for airway management during the advanced cardiac life support phase of cardiopulmonary resuscitation of patients with out-of-hospital cardiorespiratory arrest. It has been reported as superior in terms of survival. Objectives: To assess noninferiority of BMV vs ETI for advanced airway management with regard to survival with favorable neurological function at day 28...
February 27, 2018: JAMA: the Journal of the American Medical Association
Kaan Yusufoğlu, Mehmet Özgür Erdoğan, İsmail Tayfur, Mustafa Ahmet Afacan, Şahin Çolak
Background/aim: This study aimed to evaluate traumatic thorax complications in post-CPR patients and to investigate whether or not there has been a decrease in these complications since the adoption of current chest compression recommendations. Materials and methods: Post-CPR patients with return of spontaneous circulation (ROSC) were admitted between January 2014 and January 2016 were analyzed retrospectively. Patients admitted to the ED in 2014 were resuscitated according to 2010 AHA CPR guidelines, while those admitted to the ED in 2015 were resuscitated according to current ERC CPR guidelines...
February 23, 2018: Turkish Journal of Medical Sciences
Hyung Ki Moon, Jinhee Jang, Kyu Nam Park, Soo Hyun Kim, Byung Kook Lee, Sang Hoon Oh, Kyung Woon Jeung, Seung Pill Choi, In Soo Cho, Chun Song Youn
INTRODUCTION: Predicting neurologic outcomes after cardiac arrest (CA) is challenging. This study tested the hypothesis that a quantitative analysis of diffusion weighted imaging (DWI) using the FMRIB Software Library (FSL) can predict neurologic outcomes after CA and can clarify the optimal apparent diffusion coefficient (ADC) thresholds for predicting poor neurologic outcomes. METHODS: Out-of-hospital CA patients treated with targeted temperature management (TTM) who underwent DWI were included in this study...
February 21, 2018: Resuscitation
Tuba Sarıaydın, Şeref Kerem Çorbacıoğlu, Yunsur Çevik, Emine Emektar
Purpose: This study evaluated whether serum lactate levels (SLL) at admission in patients with cardiac arrest (CA) can predict successful return of spontaneous circulation (ROSC) or short-term survival, especially within the first 24 h. Materials and methods: This prospective, observational study was conducted in the emergency department (ED) of a training and research hospital from April 2015 through February 2016. It included all patients older than 18 years who presented to the ED during the study period with non-traumatic out-of-hospital cardiac arrest (OHCA)...
December 2017: Turkish Journal of Emergency Medicine
Paola Cappello, Claudia Curcio, Giorgia Mandili, Cecilia Roux, Sara Bulfamante, Francesco Novelli
Pancreatic Ductal Adenocarcinoma (PDA) is an almost incurable radio- and chemo-resistant tumor, and its microenvironment is characterized by a strong desmoplastic reaction associated with a significant infiltration of T regulatory lymphocytes and myeloid-derived suppressor cells (Tregs, MDSC). Investigating immunological targets has identified a number of metabolic and cytoskeletal related molecules, which are typically recognized by circulating antibodies. Among these molecules we have investigated alpha-enolase (ENO1), a glycolytic enzyme that also acts a plasminogen receptor...
February 16, 2018: Cancers
Cosmin Balan, Adrian View-Kim Wong
Catecholamines are entrenched in the management of shock states. A paradigm shift has pervaded the critical care arena in recent years acknowledging their propensity to cause harm and fuel a 'death-spiral'. We present the case of a 21-year-old male following a witnessed out-of-hospital cardiac arrest who received high-quality cardiopulmonary resuscitation and standard advanced life support for refractory ventricular fibrillation until return of spontaneous circulation after 70 min. Early post-admission echocardiography revealed severe diffuse sub-basal left ventricular hypertrophy with dynamic mid-cavity obstruction and akinetic apical pouching...
February 2018: Journal of the Intensive Care Society
Rickard Lagedal, Ludvig Elfwén, Stefan James, Jonas Oldgren, David Erlinge, Ollie Östlund, Ewa Wallin, Ing-Marie Larsson, Gisela Lilja, Tobias Cronberg, Sten Rubertsson, Per Nordberg
BACKGROUND: Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA presenting with ST elevation, immediate coronary angiography and potential percutaneous coronary intervention (PCI) after return of spontaneous circulation are recommended. However, the evidence for this invasive strategy in patients without ST elevation is limited. Observational studies have shown a culprit coronary artery occlusion in about 30% of these patients, indicating the electrocardiogram's (ECG's) limited sensitivity...
March 2018: American Heart Journal
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 hours 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...
February 6, 2018: Resuscitation
Tak Kyu Oh, Young Mi Park, Sang-Hwan Do, Jung-Won Hwang, You Hwan Jo, Jin Hee Kim, Young-Tae Jeon, In-Ae Song
Because most medical staff work from Monday-Friday, it is possible that they are relatively more fatigued and less capable of providing emergency supportive services on Thursday-Sunday (Thu-Sun) than on Monday-Wednesday (Mon-Wed). In this study, we aimed to analyze the incidence of in-hospital cardiopulmonary resuscitation (CPR) to determine if it differed between Thu-Sun and Mon-Wed.This retrospective observational study of in-hospital CPR was performed during 2012 to 2016 among inpatients at the Seoul National University Bundang Hospital...
February 2018: Medicine (Baltimore)
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