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Jon c Rittenberger

Cameron Dezfulian, Maia Taft, Catherine Corey, Gabrielle Hill, Nicholas Krehel, Jon C Rittenberger, Frank X Guyette, Sruti Shiva
Remote Ischemic Conditioning (RIC), induced by brief cycles of ischemia and reperfusion, protects vital organs from a prolonged ischemic insult. While several biochemical mediators have been implicated in RIC's mechanism of action, it remains unclear whether the localization or "dose" of RIC affects the extent of protective signaling. In this randomized crossover study of healthy individuals, we tested whether the number of cycles of RIC and its localization (arm versus thigh) determines biochemical signaling and cytoprotection...
March 18, 2017: Redox Biology
Michael W Donnino, Xiaowen Liu, Lars W Andersen, Jon C Rittenberger, Benjamin S Abella, David F Gaieski, Joseph P Ornato, Raúl J Gazmuri, Anne V Grossestreuer, Michael N Cocchi, Antonio Abbate, Amy Uber, John Clore, Mary Anne Peberdy, Clifton W Callaway
INTRODUCTION: Mitochondrial injury post-cardiac arrest has been described in pre-clinical settings but the extent to which this injury occurs in humans remains largely unknown. We hypothesized that increased levels of mitochondrial biomarkers would be associated with mortality and neurological morbidity in post-cardiac arrest subjects. METHODS: We performed a prospective multicenter study of post-cardiac arrest subjects. Inclusion criteria were comatose adults who suffered an out-of-hospital cardiac arrest...
April 2017: Resuscitation
Torben K Becker, Michael Bernhard, Bernd W Böttiger, Jon C Rittenberger, Mike-Frank G Epitropoulos, Sören L Becker
No abstract text is available yet for this article.
February 2017: American Journal of Bioethics: AJOB
Joshua C Reynolds, Brian E Grunau, Jon C Rittenberger, Kelly N Sawyer, Michael C Kurz, Clifton W Callaway
BACKGROUND: Little evidence guides the appropriate duration of resuscitation in out-of-hospital cardiac arrest, and case features justifying longer or shorter durations are ill defined. We estimated the impact of resuscitation duration on the probability of favorable functional outcome in out-of-hospital cardiac arrest using a large, multicenter cohort. METHODS: This was a secondary analysis of a North American, single-blind, multicenter, cluster-randomized, clinical trial (ROC-PRIMED [Resuscitation Outcomes Consortium Prehospital Resuscitation Using an Impedance Valve and Early Versus Delayed]) of consecutive adults with nontraumatic, emergency medical services-treated out-of-hospital cardiac arrest...
December 20, 2016: Circulation
Jonathan Elmer, Jon C Rittenberger, Patrick J Coppler, Francis X Guyette, Ankur A Doshi, Clifton W Callaway
INTRODUCTION: The Institute of Medicine and American Heart Association have called for tiered accreditation standards and regionalization of post-cardiac arrest care, but there is little data to support that regionalization has a durable effect on patient outcomes. We tested the effect of treatment at a high-volume center on long-term outcome after sudden cardiac arrest (SCA). METHODS: We included patients hospitalized at one of 7 medical centers in Southwestern Pennsylvania after SCA from 2005 to 2013...
November 2016: Resuscitation
Edilberto Amorim, Jon C Rittenberger, Julia J Zheng, M Brandon Westover, Maria E Baldwin, Clifton W Callaway, Alexandra Popescu
OBJECTIVE: Hypoxic brain injury is the largest contributor to disability and mortality after cardiac arrest. We aim to identify electroencephalogram (EEG) characteristics that can predict outcome on cardiac arrest patients treated with targeted temperature management (TTM). METHODS: We retrospectively examined clinical, EEG, functional outcome at discharge, and in-hospital mortality for 373 adult subjects with return of spontaneous circulation after cardiac arrest...
December 2016: Resuscitation
Jonathan Elmer, Jon C Rittenberger
No abstract text is available yet for this article.
October 2016: Resuscitation
Patrick J Coppler, Kelly N Sawyer, Chun Song Youn, Seung Pill Choi, Kyu Nam Park, Young-Min Kim, Joshua C Reynolds, David F Gaieski, Byung Kook Lee, Joo Suk Oh, Won Young Kim, Hyung Jun Moon, Benjamin S Abella, Jonathan Elmer, Clifton W Callaway, Jon C Rittenberger
There is little consensus regarding many post-cardiac arrest care parameters. Variability in such practices could confound the results and generalizability of post-arrest care research. We sought to characterize the variability in post-cardiac arrest care practice in Korea and the United States. A 54-question survey was sent to investigators participating in one of two research groups in South Korea (Korean Hypothermia Network [KORHN]) and the United States (National Post-Arrest Research Consortium [NPARC])...
March 2017: Therapeutic Hypothermia and Temperature Management
Jacob C Jentzer, Meshe D Chonde, Asher Shafton, Hussein Abu-Daya, Didier Chalhoub, Andrew D Althouse, Jon C Rittenberger
BACKGROUND/AIMS: Echocardiographic abnormalities are common after resuscitation from cardiac arrest. The association between echocardiographic findings with vasopressor requirements and mortality are not well described. We sought to determine the associations between echocardiographic abnormalities and mortality, vasopressor requirements and organ failure after cardiac arrest. METHODS: We prospectively evaluated 55 adult subjects undergoing transthoracic echocardiography within 24h after resuscitation from cardiac arrest...
September 2016: Resuscitation
Jonathan Elmer, Jon C Rittenberger, John Faro, Bradley J Molyneaux, Alexandra Popescu, Clifton W Callaway, Maria Baldwin
OBJECTIVE: We tested the hypothesis that there are readily classifiable electroencephalographic (EEG) phenotypes of early postanoxic multifocal myoclonus (PAMM) that develop after cardiac arrest. METHODS: We studied a cohort of consecutive comatose patients treated after cardiac arrest from January 2012 to February 2015. For patients with clinically evident myoclonus before awakening, 2 expert physicians reviewed and classified all EEG recordings. Major categories included: Pattern 1, suppression-burst background with high-amplitude polyspikes in lockstep with myoclonic jerks; and Pattern 2, continuous background with narrow, vertex spike-wave discharges in lockstep with myoclonic jerks...
August 2016: Annals of Neurology
Young Joo Kim, Joan C Rogers, Ketki D Raina, Clifton W Callaway, Jon C Rittenberger, Mary Lou Leibold, Margo B Holm
AIM: The primary aim was to examine the feasibility of recruiting and retaining participants for an Energy Conservation+Problem Solving Therapy (EC+PST) intervention delivered over the telephone, to evaluate the acceptability of the intervention, and to assess the appropriateness of the outcome measures. The secondary aim was to evaluate the preliminary intervention effect on fatigue impact, activity performance, and participation in daily activities in post-cardiac arrest (CA) adults with chronic fatigue...
August 2016: Resuscitation
Patrick J Coppler, Keith A Marill, David O Okonkwo, Lori A Shutter, Cameron Dezfulian, Jon C Rittenberger, Clifton W Callaway, Jonathan Elmer
Comatose patients after cardiac arrest should receive active targeted temperature management (TTM), with a goal core temperature of 32-36°C for at least 24 hours. Small variations in brain temperature may confer or mitigate a substantial degree of neuroprotection, which may be lost at temperatures near 37°C. The purpose of this study was to define the relationship between brain and core temperature after cardiac arrest through direct, simultaneous measurement of both. We placed intracranial monitors in a series of consecutive patients hospitalized for cardiac arrest at a single tertiary care facility within 12 hours of return of spontaneous circulation to guide postcardiac arrest care...
December 2016: Therapeutic Hypothermia and Temperature Management
David Hostler, Deanna Colburn, Jon C Rittenberger, Steven E Reis
OBJECTIVE: Fire suppression is a physically demanding occupation that often results in significant heat stress and hypohydration. Guidelines for the number of work intervals allowed before a structured recovery were consensus derived and have not been tested. METHODS: Apparently healthy firefighters were recruited for this field study. Subjects were assigned to two or three bouts of live fire training prior to 20 minutes of structured recovery to provide rehydration and cooling...
April 14, 2016: Prehospital Emergency Care
Jonathan Elmer, John J Gianakas, Jon C Rittenberger, Maria E Baldwin, John Faro, Cheryl Plummer, Lori A Shutter, Christina L Wassel, Clifton W Callaway, Anthony Fabio
BACKGROUND: Existing studies of quantitative electroencephalography (qEEG) as a prognostic tool after cardiac arrest (CA) use methods that ignore the longitudinal pattern of qEEG data, resulting in significant information loss and precluding analysis of clinically important temporal trends. We tested the utility of group-based trajectory modeling (GBTM) for qEEG classification, focusing on the specific example of suppression ratio (SR). METHODS: We included comatose CA patients hospitalized from April 2010 to October 2014, excluding CA from trauma or neurological catastrophe...
December 2016: Neurocritical Care
David Hostler, Serina J McEntire, Jon C Rittenberger
Position Statement: Emergency Incident Rehabilitation The National Association of EMS Physicians® believes that: Emergency operations and training conducted while wearing protective clothing and respirators is physiologically and cognitively demanding. The heat stress and fatigue created by working in protective clothing and respirators creates additional risk of illness/injury for the public safety provider. Emergency incident rehabilitation provides a structured rest period for rehydration and correction of abnormal body core temperature following work in protective clothing and respirators...
2016: Prehospital Emergency Care
Jonathan A Janiczek, Daniel G Winger, Patrick Coppler, Alexa R Sabedra, Holt Murray, Michael R Pinsky, Jon C Rittenberger, Joshua C Reynolds, Cameron Dezfulian
PURPOSE: To determine which strategy of early post-cardiac arrest hemodynamic resuscitation was associated with best clinical outcomes. We hypothesized that higher mean arterial pressure (MAP) achieved using IV fluids over vasopressors would yield better outcomes. METHODS: Retrospective cohort study of post-cardiac arrest patients between March 2011 and June 2012. Patients successfully resuscitated from cardiac arrest, admitted to an intensive care unit and surviving at least 24 h, were included...
June 2016: Shock
Joe Suyama, Serina J McEntire, Jon C Rittenberger, Deena Rosalky, Steven E Reis, David Hostler
UNLABELLED: In many operational scenarios, hypohydration can be corrected with oral rehydration following the work interval. Although rare, there are potential situations that require extended intervals of uncompensable heat stress exposure while working in personal protective equipment (PPE). Under these conditions, retention of body water may be valuable to preserve work capacity and reduce cardiovascular strain. We conducted a pilot study comparing intramuscular atropine sulfate versus saline placebo to establish the safety profile of the protocol and to provide pilot data for future investigations...
2016: Prehospital Emergency Care
Patrick J Coppler, Jon C Rittenberger, David J Wallace, Clifton W Callaway, Jonathan Elmer
BACKGROUND: International Classification of Diseases 9th Edition's Clinical Modification (ICD-9CM) codes are frequently used in health services research. We tested the operating characteristics of ICD-9CM codes for identifying out-of-hospital cardiac arrest (OHCA) subjects. METHODS: We used ICD-9CM codes to generate an "administrative cohort" of subjects treated after possible OHCA at one of six emergency departments (EDs) between January 2010 and April 2014. We performed a structured chart review to determine proportion of this administrative cohort with actual OHCA (true positive rate for the ICD-9CM-based search method)...
January 2016: Resuscitation
Jonathan Elmer, Kwonho Jeong, Kaleab Z Abebe, Francis X Guyette, Raghavan Murugan, Clifton W Callaway, Jon C Rittenberger
OBJECTIVES: In the first days after cardiac arrest, accurate prognostication is challenging. Serum biomarkers are a potentially attractive adjunct for prognostication and risk stratification. Our primary objective in this exploratory study was to identify novel early serum biomarkers that predict survival after cardiac arrest earlier than currently possible. DESIGN: Prospective, observational study. SETTING: A single academic medical center...
January 2016: Critical Care Medicine
Jon C Rittenberger, Stuart Friess, Kees H Polderman
Cardiac arrest is the most common cause of death in North America. Neurocritical care interventions, including targeted temperature management (TTM), have significantly improved neurological outcomes in patients successfully resuscitated from cardiac arrest. Therefore, resuscitation following cardiac arrest was chosen as an emergency neurological life support protocol. Patients remaining comatose following resuscitation from cardiac arrest should be considered for TTM. This protocol will review induction, maintenance, and re-warming phases of TTM, along with management of TTM side effects...
December 2015: Neurocritical Care
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