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https://www.readbyqxmd.com/read/29239942/targeted-temperature-management-after-cardiac-arrest-systematic-review-and-meta-analyses
#1
Rajat Kalra, Garima Arora, Nirav Patel, Rajkumar Doshi, Lorenzo Berra, Pankaj Arora, Navkaranbir S Bajaj
BACKGROUND: Targeted temperature management (TTM) with therapeutic hypothermia is an integral component of postarrest care for survivors. However, recent randomized controlled trials (RCTs) have failed to demonstrate the benefit of TTM on clinical outcomes. We sought to determine if the pooled data from available RCTs support the use of prehospital and/or inhospital TTM after cardiac arrest. METHODS: A comprehensive search of SCOPUS, Elsevier's abstract and citation database of peer-reviewed literature, from 1966 to November 2016 was performed using predefined criteria...
December 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29233143/relative-hyperglycemia-is-associated-with-complications-following-an-acute-myocardial-infarction-a-post-hoc-analysis-of-hi-5-data
#2
Tien F Lee, Morton G Burt, Leonie K Heilbronn, Arduino A Mangoni, Vincent W Wong, Mark McLean, N Wah Cheung
BACKGROUND: Hyperglycemia is associated with increased morbidity and mortality in patients with an acute myocardial infarction (AMI). We evaluated whether complications after AMI are associated with absolute or relative glycemia. METHODS: A total of 192 patients with AMI were randomized to intensive or conventional insulin therapy. Absolute glycemia was defined as mean blood glucose level (BGL) during the first 24 h following randomization. Relative glycemia was defined by the stress hyperglycaemia ratio (SHR), calculated as mean BGL divided by average glucose concentration over the prior 3 months estimated from glycosylated haemoglobin...
December 12, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29228147/association-of-early-postresuscitation-hypotension-with-survival-to-discharge-after-targeted-temperature-management-for-pediatric-out-of-hospital-cardiac-arrest-secondary-analysis-of-a-randomized-clinical-trial
#3
Alexis A Topjian, Russell Telford, Richard Holubkov, Vinay M Nadkarni, Robert A Berg, J Michael Dean, Frank W Moler
Importance: Out-of-hospital cardiac arrest (OHCA) occurs in more than 6000 children each year in the United States, with survival rates of less than 10% and severe neurologic morbidity in many survivors. Post-cardiac arrest hypotension can occur, but its frequency and association with survival have not been well described during targeted temperature management. Objective: To determine whether hypotension is associated with survival to discharge in children and adolescents after resuscitation from OHCA...
December 11, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/29226563/fatal-cardiac-arrest-in-pediatric-heart-transplant-recipients-query-of-the-unos-database
#4
Robert W Loar, Susan W Denfield, Shaine A Morris, Hari P Tunuguntla, Antonio G Cabrera, Jack F Price, Wei Zhang, Katherine Hosek, Jeffrey J Kim, William J Dreyer, Aamir Jeewa
The incidence of death by CA after PHTx is unknown. We aimed to determine the incidence and factors for fatal CA after PHTx, and whether a PM affects survival. Retrospective cohort study utilizing the United Network of Organ Sharing registry of patients transplanted ≤18 years. Multivariable analyses in hazard-function domain and Kaplan-Meier analyses were performed for an outcome of death due to CA. There were 7719 PHTx patients queried. CA was the reported cause of death in 11%. Age ≥13 years at time of transplant, presence of a PM, and depressed EF were identified as significant factors for fatal CA...
December 10, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/29226111/comparison-of-electronic-learning-versus-lecture-based-learning-in-improving-emergency-medicine-residents-knowledge-about-mild-induced-hypothermia-after-cardiac-arrest
#5
Maryam Soleimanpour, Farzad Rahmani, Mehrad Naghizadeh Golzari, Alireza Ala, Hamid Reza Morteza Bagi, Robab Mehdizadeh Esfanjani, Hassan Soleimanpour
Background: The process of medical education depends on several issues such as training materials, students, professors, educational fields, and the applied technologies. The current study aimed at comparing the impacts of e-learning and lecture-based learning of mild induced hypothermia (MIH) after cardiac arrest on the increase of knowledge among emergency medicine residents. Methods: In a pre- and post-intervention study, MIH after cardiac arrest was taught to 44 emergency medicine residents...
August 2017: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/29223603/factors-predicting-quality-of-life-and-societal-participation-after-survival-of-a-cardiac-arrest-a-prognostic-longitudinal-cohort-study
#6
Daan Verberne, Veronique Moulaert, Jeanine Verbunt, Caroline van Heugten
AIM: For those patients who suffer unfavourable outcome after survival of cardiac arrest, it is important to know whether this can be predicted at an early stage. Support can subsequently be provided. This study aimed to identify early prognostic factors of quality of life (QOL) and societal participation at one year post-cardiac arrest. METHODS: The design was a prospective longitudinal cohort study following cardiac arrest survivors up to one year. Prognostic personal, injury-related, function-related and subjective outcome factors were selected and entered into a hierarchical regression model to assess whether they were predictive of QOL and societal participation at one year post-cardiac arrest...
December 6, 2017: Resuscitation
https://www.readbyqxmd.com/read/29223601/early-coronary-angiography-and-percutaneous-coronary-intervention-are-associated-with-improved-outcomes-after-out-of-hospital-cardiac-arrest
#7
Jacob C Jentzer, Michael Scutella, Francis Pike, James Fitzgibbon, Nicholas M Krehel, Lindsay Kowalski, Clifton W Callaway, Jon C Rittenberger, Joshua C Reynolds, Gregory W Barsness, Cameron Dezfulian
AIM: Early coronary angiography (CAG) and percutaneous coronary intervention (PCI) are associated with better outcomes in subjects resuscitated from out-of-hospital cardiac arrest (OHCA). We sought to determine the relative contributions of early CAG and PCI to outcomes and adverse events after OHCA. METHODS: We analyzed 599 OHCA subjects from a prospective two-center registry. Hospital survival, functional outcomes and adverse events were compared between subjects undergoing early CAG (within 24h) with or without PCI and subjects not undergoing early CAG...
December 6, 2017: Resuscitation
https://www.readbyqxmd.com/read/29221942/neurostimulant-use-is-associated-with-improved-survival-in-comatose-patients-after-cardiac-arrest-regardless-of-electroencephalographic-substrate
#8
Alexis Steinberg, Jon C Rittenberger, Maria Baldwin, John Faro, Alexandra Urban, Naoir Zaher, Clifton W Callaway, Jonathan Elmer
AIM: Identify EEG patterns that predict or preclude favorable response in comatose post-arrest patients receiving neurostimulants. METHODS: We examined a retrospective cohort of consecutive electroencephalography (EEG)-monitored comatose post-arrest patients. We classified the last day of EEG recording before neurostimulant administration based on continuity (continuous/discontinuous), reactivity (yes/no) and malignant patterns (periodic discharges, suppression burst, myoclonic status epilepticus or seizures; yes/no)...
December 5, 2017: Resuscitation
https://www.readbyqxmd.com/read/29221300/comparison-of-continuous-compression-with-regular-ventilations-versus-30-2-compressions-ventilations-strategy-during-mechanical-cardiopulmonary-resuscitation-in-a-porcine-model-of-cardiac-arrest
#9
Zhengfei Yang, Qingyu Liu, Guanghui Zheng, Zhifeng Liu, Longyuan Jiang, Qing Lin, Rui Chen, Wanchun Tang
Background: A compression-ventilation (C:V) ratio of 30:2 is recommended for adult cardiopulmonary resuscitation (CPR) by the current American Heart Association (AHA) guidelines. However, continuous chest compression (CCC) is an alternative strategy for CPR that minimizes interruption especially when an advanced airway exists. In this study, we investigated the effects of 30:2 mechanical CPR when compared with CCC in combination with regular ventilation in a porcine model. Methods: Sixteen male domestic pigs weighing 39±2 kg were utilized...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29217853/comprehensive-cardiopulmonary-life-support-ccls-for-cardiopulmonary-resuscitation-by-trained-paramedics-and-medics-inside-the-hospital
#10
Rakesh Garg, Syed Moied Ahmed, Mukul Chandra Kapoor, Ssc Chakra Rao, Bibhuti Bhusan Mishra, M Venkatagiri Kalandoor, Baljit Singh, Jigeeshu Vasishtha Divatia
The cardiopulmonary resuscitation (CPR) guideline of comprehensive cardiopulmonary life support (CCLS) for management of the patient with cardiopulmonary arrest in adults provides an algorithmic step-wise approach for optimal outcome of the patient inside the hospital by trained medics and paramedics. This guideline has been developed considering the infrastructure of healthcare delivery system in India. This is based on evidence in the international and national literature. In the absence of data from the Indian population, the extrapolation has been made from international data, discussed with Indian experts and modified accordingly to ensure their applicability in India...
November 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/29214676/platelet-function-monitoring-for-stent-thrombosis-in-critically-iii-patients-with-an-acute-coronary-syndrome
#11
Lisa Tilemann, Sarah K Mohr, Michael Preusch, Emanuel Chorianopoulos, Evangelos Giannitsis, Hugo A Katus, Oliver J Müller
BACKGROUND: Patients after cardiac arrest or in cardiogenic shock due to acute coronary syndrome (ACS) are at high risk for stent thrombosis (ST) and recurrent cardiovascular events after primary percutaneous coronary intervention (PCI). High post-interventional platelet reactivity (HPR) might be an additional risk factor for ST in these critically ill patients. METHODS: Between 2006 and 2016, 401 critically ill patients from a cardiologic intensive care unit underwent platelet function testing after primary PCI using whole blood impedance aggregometry...
December 6, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29207113/spontaneous-hypothermia-ameliorated-inflammation-and-neurologic-deficit-in-rat-cardiac-arrest-models-following-resuscitation
#12
Minggen Zhou, Peng Wang, Zhengfei Yang, Haidong Wu, Zitong Huan
Cardiac arrest (CA) is a leading cause of mortality worldwide. The majority of the associated mortalities are caused by post‑CA syndrome, which includes symptoms, such as neurologic damage, myocardial dysfunction and systemic inflammation. Following CA, return of spontaneous circulation (ROSC) leads to a brain reperfusion injury, which subsequently causes adverse neurologic outcomes or mortality. Therefore, investigating the underlying mechanisms of ROSC‑induced neurologic deficits and establishing potential treatments is critical to prevent and treat post‑CA syndrome...
November 20, 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29205502/intraoperative-thermographic-imaging-to-assess-myocardial-distribution-of-del-nido-cardioplegia
#13
Prashant Rao, Jack B Keenan, Taufiek K Rajab, Alice Ferng, Samuel Kim, Zain Khalpey
We describe the intraoperative non-invasive use of an infrared (IR) camera to monitor Del Nido cardioplegia delivery in patients undergoing cardiac surgery. Thermal pictures were taken pre- and post-cardioplegia and at timed points after arrest, and compared to readings from a transseptal temperature probe. There was good concordance between the transseptal probe and the IR camera temperature readings. This non-invasive technique, which assesses cardioplegic distribution, may help to determine when additional doses of Del Nido cardioplegia are required during periods of cardioplegic arrest...
December 3, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/29201544/occurrence-of-overt-seizures-in-comatose-survivor-patients-treated-with-targeted-temperature
#14
Anda Eilam, Volodymyr Samogalskyi, Gennady Bregman, Sarit Eliner-Avishai, Ronit Gilad
Background: Unconscious patients after out-of-hospital cardiac arrest have a high risk of death. Therapeutic hypothermia is recommended by international resuscitation guidelines in order to attenuate secondary destructive physiological processes such as reperfusion injury, apoptosis, and cerebral edema. The target temperature to reach ranges between 32 and 34°C for at least 24 hr. Hypothermia can induce metabolic disturbances. There are some reports in the literature indicating the presence of seizures during targeted temperature management...
November 2017: Brain and Behavior
https://www.readbyqxmd.com/read/29197598/effect-of-sedation-on-quantitative-electroencephalography-after-cardiac-arrest
#15
Callie M Drohan, Alessandra I Cardi, Jon C Rittenberger, Alexandra Popescu, Clifton W Callaway, Maria E Baldwin, Jonathan Elmer
BACKGROUND: Electroencephalography (EEG) has clinical and prognostic importance after cardiac arrest (CA). Recently, interest in quantitative EEG (qEEG) analysis has grown. The qualitative effects of sedation on EEG are well known, but potentially confounding effects of sedatives on qEEG after anoxic injury are poorly characterized. We hypothesize that sedation increases suppression ratio (SR) and decreases alpha/delta ratio (ADR) and amplitude-integrated EEG (aEEG), and that the magnitude of sedation effects will be associated with outcome...
November 29, 2017: Resuscitation
https://www.readbyqxmd.com/read/29192562/cerebral-microcirculatory-alterations-and-the-no-reflow-phenomenon-in%C3%A2-vivo-after-experimental-pediatric-cardiac-arrest
#16
Lingjue Li, Samuel M Poloyac, Simon C Waltkins, Claudette M St Croix, Henry Alexander, Gregory A Gibson, Patricia A Loughran, Levent Kirisci, Robert Sb Clark, Patrick M Kochanek, Alberto L Vazquez, Mioara D Manole
Decreased cerebral blood flow (CBF) after cardiac arrest (CA) contributes to secondary ischemic injury in infants and children. We previously reported cortical hypoperfusion with tissue hypoxia early in a pediatric rat model of asphyxial CA. In order to identify specific alterations as potential therapeutic targets to improve cortical hypoperfusion post-CA, we characterize the CBF alterations at the cortical microvascular level in vivo using multiphoton microscopy. We hypothesize that microvascular constriction and disturbances of capillary red blood cell (RBC) flow contribute to cortical hypoperfusion post-CA...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/29189347/the-glucagon-like-peptide-1-analog-exenatide-increases-blood-glucose-clearance-lactate-clearance-and-heart-rate-in-comatose-patients-after-out-of-hospital-cardiac-arrest
#17
Sebastian Wiberg, Jesper Kjaergaard, Henrik Schmidt, Jakob Hartvig Thomsen, Martin Frydland, Matilde Winther-Jensen, Matias Greve Lindholm, Dan Eik Høfsten, Thomas Engstrøm, Lars Køber, Jacob Eifer Møller, Christian Hassager
OBJECTIVES: To investigate the effects of the glucagon-like peptide-1 analog exenatide on blood glucose, lactate clearance, and hemodynamic variables in comatose, resuscitated out-of-hospital cardiac arrest patients. DESIGN: Predefined post hoc analyzes from a double-blind, randomized clinical trial. SETTING: The ICU of a tertiary heart center. PATIENTS: Consecutive sample of adult, comatose patients undergoing targeted temperature management after out-of-hospital cardiac arrest from a presumed cardiac cause, irrespective of the initial cardiac rhythm...
November 20, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29184335/johann-bernhard-aloys-von-gudden-and-the-mad-king-of-bavaria
#18
Kalyan B Bhattacharyya
Bernhard von Gudden was a psychiatrist in Prussia and he was summoned in March 1886 to examine King Ludwig II for his apparently insane activities like, profligate spending and erratic behaviour. A team of four estimable psychiatrists pronounced that he was not capable ruling. Consequently, he was dethroned and kept in a castle under supervision of von Gudden. Gudden championed the idea of 'no restraint' and advocated free movement of insane persons and one evening in June, he accompanied the King during an evening stroll to a lake...
October 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/29175085/ventilator-management-and-respiratory-care-after-cardiac-arrest-oxygenation-ventilation-infection-and-injury
#19
REVIEW
Nicholas J Johnson, David J Carlbom, David F Gaieski
Return of spontaneous circulation after cardiac arrest results in a systemic inflammatory state called the post-cardiac arrest syndrome, characterized by oxidative stress, coagulopathy, neuronal injury, and organ dysfunction. Perturbations in oxygenation and ventilation may exacerbate secondary injury after cardiac arrest, and have been shown to be associated with poor outcome. Further, patients who suffer cardiac arrest are at risk for a number of other pulmonary complications. Up to 70% of patients experience early infection after cardiac arrest, and the respiratory tract is the most common source...
November 21, 2017: Chest
https://www.readbyqxmd.com/read/29174327/a-case-of-cardiac-arrest-associated-with-aortic-valve-regurgitation
#20
Hyun Suk Chai, Suk Woo Lee, Jung Soo Park, Sang Chul Kim, Ji Han Lee, Hoon Kim
Blunt chest trauma can cause not only damage to the thoracic cage, but can also injure intracardiac structures including the papillary muscles, chordae tendineae, and valve leaflets. Aortic valve (AV) injury secondary to blunt chest trauma is a rare occurrence. Clinically, AV injury may be missed during the initial post-trauma assessment due to the lack of suspicion of cardiac involvement. Thus, the diagnosis of AV injury is often delayed or missed for a time interval of days to months. As a consequence, the traumatic AV regurgitation can rapidly or progressively lead to congestive heart failure unless surgically corrected...
November 20, 2017: American Journal of Emergency Medicine
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