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Circulatory arrest

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
Yuwen Shen, Chuanzhen Liu, Changcun Fang, Jie Xi, Shuming Wu, Xinyan Pang, Guangmin Song
OBJECTIVE: To study the risk factors of oxygenation impairment in patients with type-A acute aortic dissection who underwent total arch replacement with a stented elephant trunk. METHODS: In this study, 169 consecutive patients were enrolled who were diagnosed with type-A acute aortic dissection and underwent a total arch replacement procedure at the Qilu Hospital of Shandong University between January 2015 and February 2017. Postoperative oxygenation impairment was defined as arterial oxygen partial pressure/inspired oxygen fraction ≤ 200 with positive end expiratory pressure ≥ 5 cm H2 O that occurred within 72 hours of surgery...
February 14, 2018: Journal of Thoracic and Cardiovascular Surgery
Kangjun Shen, Xinmin Zhou, Ling Tan, Feng Li, Jun Xiao, Hao Tang
BACKGROUND: We hypothesized that the arch-first procedure without extra devices under moderate-to-mild systemic hypothermia during acute type A aortic dissection is safe and efficient and will improve patient outcome compared with the standard total arch replacement technique. METHODS: From December 2014 to February 2017, 89 patients were enrolled in this study, 52 of whom underwent conventional deep hypothermic circulatory arrest (DHCA, 24.2 ± 0.71°C) using the antegrade cerebral perfusion surgical procedure (Group A) and 37 of whom underwent the "arch-first" technique with moderate (27...
March 12, 2018: Journal of Cardiovascular Surgery
Åsa Lidén, Tine Veronika Karlsen, Bengt Guss, Rolf K Reed, Kristofer Rubin
NEW FINDINGS: What is the central question of this study? Collagen-binding β1 -integrins function physiologically in cellular control of dermal interstitial fluid pressure (PIF ) in vivo and thereby participate in control of extravascular fluid volume. During anaphylaxis, simulated by injection of Compound 48/80 integrin αV β3 takes over this physiological function. Here we addressed the question whether integrin αV β3 can replace collagen-binding β1 -integrin to maintain a long-term homeostatic PIF ...
March 10, 2018: Experimental Physiology
Konstantinos Karatolios, Georgios Chatzis, Birgit Markus, Ulrich Luesebrink, Holger Ahrens, Wolfgang Dersch, Susanne Betz, Birgit Ploeger, Elisabeth Boesl, William O'Neill, Clemens Kill, Bernhard Schieffer
AIMS: To compare survival outcomes of Impella support and medical treatment in patients with post-cardiac arrest cardiogenic shock related to acute myocardial infarction (AMI). METHODS: Retrospective single center study of patients resuscitated from out of hospital cardiac arrest (OHCA) due to AMI with post-cardiac arrest cardiogenic shock between September 2014 and September 2016. Patients were either assisted with Impella or received medical treatment only. Survival outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between both groups...
March 6, 2018: Resuscitation
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
Stiljan Hoxha, Riccardo Giuseppe Abbasciano, Camilla Sandrini, Lucia Rossetti, Tiziano Menon, Luca Barozzi, Daniele Linardi, Alessio Rungatscher, Giuseppe Faggian, Giovanni Battista Luciani
Aortic arch repair in newborns and infants has traditionally been accomplished using a period of deep hypothermic circulatory arrest. To reduce neurologic and cardiac dysfunction related to circulatory arrest and myocardial ischemia during complex aortic arch surgery, an alternative and novel strategy for cerebro-myocardial protection was recently developed, where regional low-flow perfusion is combined with controlled and independent coronary perfusion. The aim of the present retrospective study was to assess short-term and mid-term results of selective and independent cerebro-myocardial perfusion in neonatal aortic arch surgery...
March 6, 2018: Artificial Organs
Hiraku Funakoshi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
High-risk pulmonary embolism (PE) with hypotension, circulatory failure, or cardiac arrest is a rare, but life-threating condition. Many guidelines recommend that thrombolytic therapy is the first-line therapy for this condition and surgical embolectomy is an alternative treatment. However, nationwide data have been lacking on patient characteristics and practice patterns for high-risk PE in a real-world clinical setting.We defined high-risk PE patients as those who received noradrenaline and underwent surgical embolectomy or thrombolysis within one day after admission...
March 5, 2018: International Heart Journal
Michael L O'Byrne, Kevin F Kennedy, Joshua P Kanter, John T Berger, Andrew C Glatz
BACKGROUND: Cardiac catheterization is the gold standard for assessment and follow-up of patients with pulmonary hypertension (PH). To date, there are limited data about the factors that influence the risk of catastrophic adverse events after catheterization in this population. METHODS AND RESULTS: A retrospective multicenter cohort study was performed to measure risk of catastrophic adverse outcomes after catheterization in children and young adults with PH and identify risk factors for these outcomes...
February 28, 2018: Journal of the American Heart Association
Hesham Alkady, Sobhy Abouramadan, Mohamed Nagy, Ahmed Talaat, Tarek Hashem, Abdalla Khaleel
Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a strong association with endometriosis. Although having better prognosis than other sarcomas, yet these tumors may relapse (whether local or distant) in up to 56% of cases, even as late as 20 years after surgery. We report a case of a 30-year-old female patient with a mass in the inferior vena cava and right atrium which was surgically removed using cardiopulmonary bypass and deep hypothermic circulatory arrest and turned to be an entometrioid stromal sarcoma...
February 27, 2018: General Thoracic and Cardiovascular Surgery
Oscar Thabouillot, K Bertho, E Rozenberg, N-C Roche, G Boddaert, D Jost, J-P Tourtier
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014...
February 27, 2018: Journal of the Royal Army Medical Corps
Sachin Talwar, Bharat Siddarth, Shiv K Choudhary, Balram Airan
We report a 3-month-old male presenting with multiple aortic aneurysms arising de novo 2 months following the arterial switch operation. Successful repair of the aneurysms was performed under total circulatory arrest and at seven years follow-up, the patient has no recurrence.
February 27, 2018: Journal of Cardiac Surgery
Riki Ninomiya, Akiko Nakazawa, Tetsuya Mitsui, Yoichi Miyata, Masahiko Komagome, Fumiaki Ozawa, Yoshifumi Beck, Akihito Minegishi, Hideaki Yamabi, Kazuhito Imanaka
A 77-year-old man underwent extended right lobectomy of the liver for rupture of hepatocellular carcinoma. Recurrence in the inferior vena cava andright atrium was noted 30 months after surgery. We performedextirpation of this tumor thrombosis under retrograde cerebral perfusion during deep hypothermic circulatory arrest. The pericardium was cut through sternotomy, and cooling was initiated. After cardiac arrest at 20.4°C, the inferior vena cava was separated. An incision was made in the right atrium andthe tumor thrombus was extirpated...
February 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Fan Qiao, Cunhua Su, Qingqi Han, Mengwei Tan, Jun Wang, Yang Liu, Fanglin Lu, Lin Han, Zhiyun Xu
PURPOSE: To report the results of a hybrid approach to aortic arch repair using an innovative unibody double-branched stent graft in a canine model. MATERIALS AND METHODS: The stent-graft system consists of two parts: the main body and two branches for reconstruction of the supra-arch branches. There is a 2-cm-long suturing portion at the proximal end of the main body. Twenty adult German sheep dogs underwent a hybrid surgical treatment to place the stent-grafts into the proximal descending aorta and the supra-arch branches...
February 22, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Christoph Hanefeld, Alexander Haschemi, Thomas Lampert, Hans J Trampisch, Andreas Mügge, Janine Miebach, Cordula Kloppe, Renate Klaaßen-Mielke
BACKGROUND: Persons of lower socio-economic status are at higher risk of disease, especially with respect to severe and chronic illnesses. To date, there have not been any studies with large case numbers regarding acute medical emergencies in this population. METHODS: In a retrospective study, data were obtained on all cases treated by emergency physicians in Bochum, Germany, in 2014/2015, including the diagnoses that were made by the emergency physicians. There were a total of 16 767 cases...
January 26, 2018: Deutsches Ärzteblatt International
Federico Pappalardo, Anna Mara Scandroglio, Azeem Latib
Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation...
February 21, 2018: ESC Heart Failure
Francisco Estevez-Cid, Jose María Herrera-Norena, Carlos Velasco-García de Sierra
We describe the "auto-sliding graft" technique, a different anastomotic option for reconstructive prosthetic procedures on the ascending aorta especially in patients at risk of circulatory arrest with mild aortic dilatation. This simple technique provides not only an important hemostatic reinforcement for the distal aortic graft anastomosis but also a protective effect on the native ascending aorta beyond the suture line.
February 20, 2018: Thoracic and Cardiovascular Surgeon
Jacopo Alfonsi, Giacomo Murana, Henri G Smeenk, Hans Kelder, Marc Schepens, Uday Sonker, Wim J Morshuis, Robin H Heijmen
OBJECTIVES: Chronic, post-dissection thoraco-abdominal aortic aneurysms (TAAAs) are increasingly being treated by (hybrid) endovascular means. Although it is less invasive, thoracic endovascular aortic repair is technically complex with the risk of incomplete aneurysm exclusion, necessitating frequent reinterventions with potentially reduced long-term outcomes. The aim of this study was to evaluate contemporary early and late outcomes after open surgical repair of post-dissection TAAA...
February 16, 2018: European Journal of Cardio-thoracic Surgery
Brody Wehman, Michael Mazzeffi, Robert Chow, A Claire Watkins, Brittany Aicher, Si Pham, Whitney Burrows, Bradley Taylor
We report a patient with refractory electrical storm after coronary artery bypass grafting who was successfully treated with thoracoscopic sympathectomy. Cardiac arrest with ventricular tachycardia occurred on postoperative day 2, and the patient required emergency support with venoarterial extracorporeal membrane oxygenation. Frequent episodes of ventricular tachycardia prevented cardiac recovery and weaning from mechanical circulatory support. A percutaneous left stellate ganglion block initially demonstrated successful prevention of ventricular tachycardia, and definitive sympathetic denervation was achieved by a left thoracoscopic sympathectomy...
March 2018: Annals of Thoracic Surgery
Kuang-Hueih Chen, Asish Dasgupta, Jianhui Lin, Francois Potus, Sebastien Bonnet, James Iremonger, Jennifer Fu, Jeffrey Mewburn, Danchen Wu, Kimberly Dunham-Snary, Anne L Theilmann, Zhi-Cheng Jing, Charles Hindmarch, Mark L Ormiston, Allan Lawrie, Stephen L Archer
Background -Mitotic fission is increased in pulmonary arterial hypertension (PAH), a hyperproliferative, apoptosis-resistant disease. The fission mediator, dynamin related protein 1 (Drp1) must complex with adaptor proteins to cause fission. Drp1-induced fission has been therapeutically targeted in experimental PAH. Here we examine the role of two recently discovered, poorly understood, Drp1 adapter proteins, mitochondrial dynamics protein of 49 and 51 kDa (MiD49 and MiD51) in normal vascular cells and explore their dysregulation in PAH...
February 5, 2018: Circulation
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