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https://www.readbyqxmd.com/read/28447885/recovery-from-coma-post-cardiac-arrest-is-dependent-on-the-orexin-pathway
#1
Young-Jin Kang, Guilian Tian, Afsheen Bazrafkan, Maryam H Farahabadi, Matine Azadian, Hamidreza Abbasi, Brittany Shamaoun, Oswald Steward, Yama Akbari
Cardiac arrest affects >550,000 people annually in the USA while 80-90% of survivors suffer from a comatose state. Arousal from coma is critical for recovery but mechanisms of arousal are undefined. Orexin-A, a hypothalamic excitatory neuropeptide, has been linked to arousal deficits in various brain injuries. We investigated the orexinergic system's role in recovery from cardiac arrest-related neurological impairments, including arousal deficits. Using an asphyxial cardiac arrest and resuscitation model in rats, we examine neurological recovery post-resuscitation in conjunction with changes in orexin-A levels in cerebrospinal fluid and orexin-expressing neurons...
April 27, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28444125/sudden-cardiac-death
#2
Jagdesh Kandala, Clint Oommen, Karl B Kern
Introduction: Sudden cardiac arrest continues to be the leading cause of death in the industrialized world. Sources of data: Original papers, reviews and guidelines. Areas of agreement: Community programs for lay bystander cardiopulmonary resuscitation (CPR) and automatic external defibrillation improve outcomes. Post-arrest care, including targeted temperature management (TTM) combined with early coronary angiography and percutaneous coronary intervention, is helpful for those suffering cardiac arrest during an ST-segment elevation myocardial infarction...
April 24, 2017: British Medical Bulletin
https://www.readbyqxmd.com/read/28443357/informed-consent-and-the-aftermath-of-cardiopulmonary-resuscitation-ethical-considerations
#3
Pamela Bjorklund, Denise M Lund
BACKGROUND: Patients often are confronted with the choice to allow cardiopulmonary resuscitation (CPR) should cardiac arrest occur. Typically, informed consent for CPR does not also include detailed discussion about survival rates, possible consequences of survival, and/or potential impacts on functionality post-CPR. OBJECTIVE: A lack of communication about these issues between providers and patients/families complicates CPR decision-making and highlights the ethical imperative of practice changes that educate patients and families in those deeper and more detailed ways...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28442620/the-implementation-of-cardiac-arrest-treatment-recommendations-in-english-acute-nhs-trusts-a-national-survey
#4
James Carberry, Keith Couper, Joyce Yeung
PURPOSE OF THE STUDY: There are approximately 35 000 in-hospital cardiac arrests in the UK each year. Successful resuscitation requires integration of the medical science, training and education of clinicians and implementation of best practice in the clinical setting. In 2015, the International Liaison Committee on Resuscitation (ILCOR) published its latest resuscitation treatment recommendations. It is currently unknown the extent to which these treatment recommendations have been successfully implemented in practice in English NHS acute hospital trusts...
April 25, 2017: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/28438718/the-effect-of-50-compared-to-100-inspired-oxygen-fraction-on-brain-oxygenation-and-post-cardiac-arrest-mitochondrial-function-in-experimental-cardiac-arrest
#5
Annika Nelskyla, Jouni Nurmi, Milla Jousi, Alexey Schramko, Eero Mervaala, Giuseppe Ristagno, Markus B Skrifvars
BACKGROUND AND AIM: We hypothesised that the use of 50% compared to 100% oxygen maintains cerebral oxygenation and ameliorates the disturbance of cardiac mitochondrial respiration during cardiopulmonary resuscitation (CPR). METHODS: Ventricular fibrillation (VF) was induced electrically in anaesthetised healthy adult pigs and left untreated for seven minutes followed by randomisation to manual ventilation with 50% or 100% oxygen and mechanical chest compressions (LUCAS(®))...
April 21, 2017: Resuscitation
https://www.readbyqxmd.com/read/28438578/global-cerebral-ischemia-in-rats-leads-to-amnesiadue-to-selective-neuronal-death-followed-by-astroglial-scar-formationin-the-ca1-layer
#6
Kevin Sadelli, Jean-Claude Stamegna, Stéphane D Girard, Nathalie Baril, Guy Escoffier, Maïna Brus, Antoine D Véron, Michel Khrestchatisky, François S Roman
Global Cerebral Ischemia (GCI) occurs following cardiac arrest or neonatal asphyxia and leads to harmful neurological consequences. In most cases, patients who survive cardiac arrest develop severe cognitive and motor impairments. This study focused on learning and memory deficits associated with brain neuroanatomical reorganization that appears after GCI. The four-vessel occlusion (4VO) model was performed to produce a transient GCI. Hippocampal lesions in ischemic rats were visualized using anatomical Magnetic Resonance Imaging (aMRI)...
April 21, 2017: Neurobiology of Learning and Memory
https://www.readbyqxmd.com/read/28437237/proteomics-in-hypothermia-as-adjunctive-therapy-in-patients-with-st-segment-elevation-myocardial-infarction-a-chill-mi-substudy
#7
Moman A Mohammad, Marco Noc, Irene Lang, Michael Holzer, Peter Clemmensen, Ulf Jensen, Bernhard Metzler, David Erlinge
Cardiovascular and inflammatory biomarkers in therapeutic hypothermia have been studied in cardiac arrest, but data on patients with ST-segment elevation myocardial infarction (STEMI) treated with therapeutic hypothermia are currently unavailable. A multiplex proximity extension assay allowed us to measure 157 cardiovascular disease (CVD) and inflammatory disease-related biomarkers in patients from the international, multicenter, and randomized trial; CHILL-myocardial infarction (MI) and to explore the associations of cardiovascular and inflammatory biomarkers...
March 2, 2017: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/28435897/association-between-lactate-clearance-during-post-resuscitation-care-and-neurologic-outcome-in-cardiac-arrest-survivors-treated-with-targeted-temperature-management
#8
Jung Chang Kim, Byung Kook Lee, Dong Hun Lee, Yong Hun Jung, Yong Soo Cho, Sung Min Lee, Seung Joon Lee, Chi Ho Park, Kyung Woon Jeung
OBJECTIVE: We investigated the association between lactate clearance or serum lactate levels and neurologic outcomes or in-hospital mortality in cardiac arrest survivors who were treated with targeted temperature management (TTM). METHODS: A retrospective analysis of data from cardiac arrest survivors treated with TTM between 2012 and 2015 was conducted. Serum lactate levels were measured on admission and at 12, 24, and 48 hours following admission. Lactate clearance at 12, 24, and 48 hours was also calculated...
March 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/28434268/ubiquitin-c-terminal-hydrolase-l1-uch-l1-as-a-therapeutic-and-diagnostic-target-in-neurodegeneration-neurotrauma-and-neuro-injuries
#9
Kevin K Wang, Zhihui Yang, George Sarkis, Isabel Torres, Vijaya Raghavan
Since its discovery as a major CNS-abundant protein 25 years ago, Ubiquitin C-terminal hydrolase-L1 (UCH-L1) has emerged as an important enzyme in regulating brain protein metabolism, by coupling to the proteasome pathway of protein degradation. Areas covered: UCH-L1 is implicated in both familial and sporadic Parkinson disease and other chronic neurodegenerative diseases. Also, UCH-L1 has been recently emerging as a biofluid-based biomarker for various forms of acute neurotrauma and CNS injury. Expert opinion: The loss of UCH-L1 activity coupled with the gain of proteinopathy function are linked to neurodegeneration such as Parkinsonism and Alzheimer's disease...
April 24, 2017: Expert Opinion on Therapeutic Targets
https://www.readbyqxmd.com/read/28427881/association-of-time-from-arrest-to-percutaneous-coronary-intervention-with-survival-outcomes-after-out-of-hospital-cardiac-arrest
#10
Joo Jeong, Young Sun Ro, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong, Ki Ok Ahn
BACKGROUND: Timely post-resuscitation coronary reperfusion therapy is recommended; however, the timing of immediate coronary reperfusion for out-of-hospital cardiac arrest (OHCA) has not been established. We studied the effect of the time interval from arrest to percutaneous coronary intervention (PCI) on resuscitated OHCA patients. METHODS: All witnessed OHCA patients with a presumed cardiac etiology received successful PCI at hospitals between 2013 and 2015, excluding cases with unknown information regarding the time from arrest to PCI and survival outcomes...
April 17, 2017: Resuscitation
https://www.readbyqxmd.com/read/28422540/evaluating-barriers-to-bystander-cpr-among-laypersons-before-and-after-compression-only-cpr-training
#11
Andrew J Bouland, Megan H Halliday, Angela C Comer, Matthew J Levy, Kevin G Seaman, Benjamin J Lawner
OBJECTIVE: Bystander CPR is an essential part of out-of-hospital cardiac arrest (OHCA) survival. EMS and public safety jurisdictions have embraced initiatives to teach compression-only CPR to laypersons in order to increase rates of bystander CPR. We examined barriers to bystander CPR amongst laypersons participating in community compression-only CPR training and the ability of the training to alleviate these barriers. The barriers analyzed include fear of litigation, risk of disease transmission, fear of hurting someone as a result of doing CPR when unnecessary, and fear of hurting someone as a result of doing CPR incorrectly...
April 19, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28419573/impella-2-5-initiated-prior-to-unprotected-left-main-pci-in-acute-myocardial-infarction-complicated-by-cardiogenic-shock-improves-early-survival
#12
Perwaiz M Meraj, Rajkumar Doshi, Theodore Schreiber, Brijeshwar Maini, William W O'Neill
OBJECTIVES: To assess post-procedural outcomes when Impella 2.5 percutaneous left ventricular assist device (pLVAD) support is initiated either prior to or after percutaneous coronary intervention (PCI) on unprotected left main coronary artery (ULMCA) culprit lesion in the context of acute myocardial infarction cardiogenic shock (AMICS). BACKGROUND: Initiation of Impella 2.5 pLVAD prior to PCI is associated with significant survival benefit in the setting of AMICS...
April 17, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28419060/relationship-of-hospital-costs-with-mortality-in-pediatric-critical-care-a-multi-institutional-analysis
#13
Punkaj Gupta, Mallikarjuna Rettiganti
OBJECTIVE: With increasing emphasis on high "value" care, we designed this study to evaluate the relationship between hospital costs and patient outcomes in pediatric critical care. DESIGN: Post hoc analysis of data from an existing administrative national database, Pediatric Health Information Systems. Multivariable mixed effects logistic regression models were fitted to evaluate association of hospital cost tertiles with odds of mortality after adjusting for patient and center characteristics...
April 17, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28410590/early-predictors-of-poor-outcome-after-out-of-hospital-cardiac-arrest
#14
Louise Martinell, Niklas Nielsen, Johan Herlitz, Thomas Karlsson, Janneke Horn, Matt P Wise, Johan Undén, Christian Rylander
BACKGROUND: Early identification of predictors for a poor long-term outcome in patients who survive the initial phase of out-of-hospital cardiac arrest (OHCA) may facilitate future clinical research, the process of care and information provided to relatives. The aim of this study was to determine the association between variables available from the patient's history and status at intensive care admission with outcome in unconscious survivors of OHCA. METHODS: Using the cohort of the Target Temperature Management trial, we performed a post hoc analysis of 933 unconscious patients with OHCA of presumed cardiac cause who had a complete 6-month follow-up...
April 13, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28408349/early-effects-of-prolonged-cardiac-arrest-and-ischemic-postconditioning-during-cardiopulmonary-resuscitation-on-cardiac-and-brain-mitochondrial-function-in-pigs
#15
Timothy R Matsuura, Jason A Bartos, Adamantios Tsangaris, Kadambari Chandra Shekar, Matthew D Olson, Matthias L Riess, Martin Bienengraeber, Tom P Aufderheide, Robert W Neumar, Jennifer N Rees, Scott H McKnite, Anna E Dikalova, Sergey I Dikalov, Hunter F Douglas, Demetris Yannopoulos
Background Out-of-hospital cardiac arrest (CA) is a prevalent medical crisis resulting in severe injury to the heart and brain and an overall survival of less than 10 percent. Mitochondrial dysfunction is predicted to be a key determinant of poor outcomes following prolonged CA. However, the onset and severity of mitochondrial dysfunction during CA and cardiopulmonary resuscitation (CPR) is not fully understood. Ischemic postconditioning (IPC), controlled pauses during the initiation of CPR, has been shown to improve cardiac function and neurologically favorable outcomes after fifteen minutes of CA...
April 10, 2017: Resuscitation
https://www.readbyqxmd.com/read/28393777/methylene-blue-for-postcardiopulmonary-bypass-vasoplegic-syndrome-a-cohort-study
#16
Michael Mazzeffi, Benjamin Hammer, Edward Chen, Mark Caridi-Scheible, James Ramsay, Christopher Paciullo
BACKGROUND: Methylene blue (MB) has been used to treat refractory hypotension in a variety of settings. AIMS: We sought to determine whether MB improved blood pressure in postcardiopulmonary bypass (CPB) vasoplegic syndrome (VS) in a complex cardiac surgery population. Furthermore, to determine variables that predicted response to MB. SETTING AND DESIGN: This was conducted in a tertiary care medical center; this study was a retrospective cohort study...
April 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28388526/sepsis-associated-in-hospital-cardiac-arrest-epidemiology-pathophysiology-and-potential-therapies
#17
REVIEW
Ryan W Morgan, Julie C Fitzgerald, Scott L Weiss, Vinay M Nadkarni, Robert M Sutton, Robert A Berg
Sepsis-associated cardiac arrest is a relatively common occurrence with especially poor outcomes. Of the greater than 200,000 in-hospital cardiac arrests that occur in the United States annually, between 30,000 and 60,000 occur in patients with underlying sepsis. These patients are less likely to survive than cardiac arrest victims without sepsis. In this review, we discuss the epidemiology of sepsis-associated in-hospital cardiac arrest in adults and children, the relevant physiology responsible for its pathogenesis and poor outcomes, and potential therapeutic interventions based on this pathophysiology...
March 31, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28379800/body-weight-fluctuations-and-outcomes-in-coronary-disease
#18
RANDOMIZED CONTROLLED TRIAL
Sripal Bangalore, Rana Fayyad, Rachel Laskey, David A DeMicco, Franz H Messerli, David D Waters
BACKGROUND: Body-weight fluctuation is a risk factor for death and coronary events in patients without cardiovascular disease. It is not known whether variability in body weight affects outcomes in patients with coronary artery disease. METHODS: We determined intraindividual fluctuations in body weight from baseline weight and follow-up visits and performed a post hoc analysis of the Treating to New Targets trial, which involved assessment of the efficacy and safety of lowering low-density lipoprotein cholesterol levels with atorvastatin...
April 6, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28377297/effect-of-prolonged-targeted-temperature-management-on-left-ventricular-myocardial-function-after-out-of-hospital-cardiac-arrest-a-randomised-controlled-trial
#19
Anders Morten Grejs, Bent Roni Ranghøj Nielsen, Peter Juhl-Olsen, Jakob Gjedsted, Erik Sloth, Johan Heiberg, Christian Alcaraz Frederiksen, Anni Nørgaard Jeppesen, Christophe Henri Valdemar Duez, Per Dreyer Hamre, Eldar Søreide, Hans Kirkegaard
AIM: To evaluate post-cardiac arrest myocardial dysfunction during prolonged targeted temperature management (TTM) compared with standard TTM in comatose out-of-hospital cardiac arrest (OHCA) survivors. METHODS: A randomised, controlled trial comparing myocardial function after TTM at 33 ±1°C for 48h compared with 24h. A total of 105 OHCA patients were computer-randomised to 24h (n=50) or 48h (n=55) of TTM. Transthoracic echocardiography was performed after 24h, 48h and 72h...
April 2, 2017: Resuscitation
https://www.readbyqxmd.com/read/28377294/a-survey-on-general-and-temperature-management-of-post-cardiac-arrest-patients-in-large-teaching-and-university-hospitals-in-14-european-countries-the-spame-trial-results
#20
Christian Storm, J Nee, Kjetil Sunde, Michael Holzer, Pia Hubner, Fabio Silvio Taccone, Hans Friberg, Esteban Lopez-de-Sa, Alain Cariou, Joerg C Schefold, Giuseppe Ristagno, Marko Noc, Dirk W Donker, Janusz Andres, Pawel Krawczyk, Markus B Skrifvars, James Penketh, Alexander Krannich, Michael Fries
INTRODUCTION: International guidelines recommend a bundle of care, including targeted temperature management (TTM), in post cardiac arrest survivors. Aside from a few small surveys in different European countries, adherence to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) recommendations are unknown. METHODS: This international European telephone survey was conducted to provide an overview of current clinical practice of post cardiac arrest management with a main focus on TTM...
April 2, 2017: Resuscitation
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