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https://www.readbyqxmd.com/read/28915913/neurological-outcomes-and-duration-from-cardiac-arrest-to-the-initiation-of-extracorporeal-membrane-oxygenation-in-patients-with-out-of-hospital-cardiac-arrest-a-retrospective-study
#1
Takahiro Yukawa, Masahiro Kashiura, Kazuhiro Sugiyama, Takahiro Tanabe, Yuichi Hamabe
BACKGROUND: We investigated the relationship between neurological outcomes and duration from cardiac arrest (CA) to the initiation of extracorporeal membrane oxygenation (ECMO) (CA-to-ECMO) in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) and determined the ideal time at which ECPR should be performed. METHODS: During the time period in which this study was conducted, 3451 patients experienced OHCA...
September 16, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28913787/mortality-rates-and-risk-factors-for-emergent-open-repair-of-abdominal-aortic-aneurysms-in-the-endovascular-era
#2
Felice Pecoraro, Steffen Gloekler, Caecilia E Mader, Malgorzata Roos, Lyubov Chaykovska, Frank J Veith, Neal S Cayne, Nicola Mangialardi, Thomas Neff, Mario Lachat
The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality...
September 14, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28905004/gastroenteritis-aggressive-versus-slow-treatment-for-rehydration-gastro-a-pilot-rehydration-study-for-severe-dehydration-who-plan-c-versus-slower-rehydration
#3
Kirsty A Houston, Jack G Gibb, Ayub Mpoya, Nchafatso Obonyo, Peter Olupot-Olupot, Margeret Nakuya, Jennifer A Evans, Elizabeth C George, Diana M Gibb, Kathryn Maitland
BACKGROUND: The World Health Organization (WHO) rehydration management guidelines (Plan C) for children with acute gastroenteritis (AGE) and severe dehydration are widely practiced in resource-poor settings, yet have never been formally evaluated in a clinical trial. A recent audit of outcome of AGE at Kilifi County Hospital, Kenya noted that 10% of children required high dependency care (20% mortality) and a number developed fluid-related complications. The fluid resuscitation trial, FEAST, conducted in African children with severe febrile illness, demonstrated higher mortality with fluid bolus therapy and raised concerns regarding the safety of rapid intravenous rehydration therapy...
2017: Wellcome Open Research
https://www.readbyqxmd.com/read/28899418/the-effect-of-a-national-web-course-help-brain-heart-as-a-supplemental-learning-tool-before-cpr-training-a-cluster-randomised-trial
#4
Anette Nord, Leif Svensson, Andreas Claesson, Johan Herlitz, Håkan Hult, Susanne Kreitz-Sandberg, Lennart Nilsson
BACKGROUND: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation. METHODS: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention)...
September 12, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28874934/emergency-physician-performed-transesophageal-echocardiography-in-simulated-cardiac-arrest
#5
Don V Byars, Jordan Tozer, John M Joyce, Michael J Vitto, Lindsay Taylor, Turan Kayagil, Matt Jones, Matthew Bishop, Barry Knapp, David Evans
INTRODUCTION: Transesophageal echocardiography (TEE) is a well-established method of evaluating cardiac pathology. It has many advantages over transthoracic echocardiography (TTE), including the ability to image the heart during active cardiopulmonary resuscitation. This prospective simulation study aims to evaluate the ability of emergency medicine (EM) residents to learn TEE image acquisition techniques and demonstrate those techniques to identify common pathologic causes of cardiac arrest...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28839998/high-rate-of-arterial-complications-in-patients-supported-with-extracorporeal-life-support-for-drug-intoxication-induced-refractory-cardiogenic-shock-or-cardiac-arrest
#6
Matteo Pozzi, Catherine Koffel, Camelia Djaref, Daniel Grinberg, Jean Luc Fellahi, Elisabeth Hugon-Vallet, Cyril Prieur, Jacques Robin, Jean François Obadia
BACKGROUND: Cardiac failure is still a leading cause of death in drug intoxication. Extracorporeal life support (ECLS) could be used as a rescue therapeutic option in patients developing refractory cardiogenic shock or cardiac arrest. The aim of this report is to present our results of ECLS in the setting of poisoning from cardiotoxic drugs. METHODS: We included in this analysis consecutive patients who received an ECLS for refractory cardiogenic shock or in-hospital cardiac arrest due to drug intoxication...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28807037/selepressin-a-novel-selective-vasopressin-v1a-agonist-is-an-effective-substitute-for-norepinephrine-in-a-phase-iia-randomized-placebo-controlled-trial-in-septic-shock-patients
#7
James A Russell, Jean-Louis Vincent, Anne Louise Kjølbye, Håkan Olsson, Allan Blemings, Herbert Spapen, Peder Carl, Pierre-Francois Laterre, Lars Grundemar
BACKGROUND: Vasopressin is widely used for vasopressor support in septic shock patients, but experimental evidence suggests that selective V1A agonists are superior. The initial pharmacodynamic effects, pharmacokinetics, and safety of selepressin, a novel V1A-selective vasopressin analogue, was examined in a phase IIa trial in septic shock patients. METHODS: This was a randomized, double-blind, placebo-controlled multicenter trial in 53 patients in early septic shock (aged ≥18 years, fluid resuscitation, requiring vasopressor support) who received selepressin 1...
August 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28780982/validation-of-the-criteria-for-early-critical-care-resource-use-in-assessing-the-effectiveness-of-field-triage
#8
Ki Ok Ahn, Sang Chul Kim, Ju Ok Park, Sang Do Shin, Kyoung Jun Song, Ki Jeong Hong
BACKGROUND: This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15. METHODS: We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients)...
July 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28780148/intraabdominal-hypertension-abdominal-compartment-syndrome-and-the-open-abdomen
#9
REVIEW
William Kirke Rogers, Luis Garcia
Abdominal compartment syndrome (ACS) is the end point of a process whereby massive interstitial swelling in the abdomen or rapid development of a space-filling lesion in the abdomen (such as ascites or a hematoma) leads to pathologically increased pressure. This results in so-called intraabdominal hypertension (IAH), causing decreased perfusion of the kidneys and abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output. These effects contribute to a cascade of ischemia and multiple organ dysfunction with high mortality...
August 2, 2017: Chest
https://www.readbyqxmd.com/read/28742797/a-comparison-of-selective-aortic-arch-perfusion-and-resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-the-management-of-hemorrhage-induced-traumatic-cardiac-arrest-a-translational-model-in-large-swine
#10
RANDOMIZED CONTROLLED TRIAL
Ed B G Barnard, James E Manning, Jason E Smith, Jason M Rall, Jennifer M Cox, James D Ross
BACKGROUND: Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA). Noncompressible torso hemorrhage (NCTH) is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) at the thoracic aorta (Zone 1) can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP) combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC) when cardiac arrest has occurred...
July 2017: PLoS Medicine
https://www.readbyqxmd.com/read/28700412/parathyroid-hormone-as-a-marker-for-hypoperfusion-in-trauma-a-prospective-observational-study
#11
Scott C Fligor, Katie M Love, Bryan R Collier, Daniel I Lollar, Mark E Hamill, Andrew D Benson, Eric H Bradburn
BACKGROUND: Hyperparathyroidism is common in critical illness. Intact parathyroid hormone has a half-life of 3 to 5 minutes due to rapid clearance by the liver, kidneys, and bone. In hemorrhagic shock, decreased clearance may occur, thus making parathyroid hormone a potential early marker for hypoperfusion. We hypothesized that early hyperparathyroidism predicts mortality and transfusion in trauma patients. METHODS: A prospective observational study was performed at a Level 1 trauma center in consecutive adult patients receiving the highest level of trauma team activation...
July 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28697025/reboa-for-the-ivc-resuscitative-balloon-occlusion-of-the-inferior-vena-cava-rebovc-to-abate-massive-hemorrhage-in-retro-hepatic-vena-cava-injuries
#12
Cassandra L Reynolds, Adam C Celio, Lindsay C Bridges, Catalina Mosquera, Brian O'Connell, Michael R Bard, Connie M DeLa'o, Eric A Toschlog
BACKGROUND: The use of resuscitative endovascular balloon occlusion as a maneuver for occlusion of the aorta is well described. This technique has life-saving potential in other cases of traumatic hemorrhage. Retro-hepatic inferior vena cava (IVC) injuries have a high rate of mortality, in part, due to the difficulty in achieving total vascular isolation. This studies purpose was to investigate the ability of resuscitative balloon occlusion of the IVC (REBOVC) to control supra-hepatic IVC hemorrhage in a swine model of trauma...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28697004/experimental-models-of-endotheliopathy-impact-of-shock-severity
#13
Nikolaus Hofmann, Johannes Zipperle, Mohammad Jafarmadar, Mostafa Ashmwe, Claudia Keibl, Carina Penzenstadler, Martin Ponschab, Behnaz Jafarmadar, Heinz Redl, Soheyl Bahrami, Herbert Schöchl
BACKGROUND: Hemorrhagic shock (HS) followed by resuscitation is often associated with sympatho-adrenal activation (SAA) and endothelial damage (ED). OBJECTIVE: We aimed to a) evaluate the impact of HS alone on the magnitude of SAA and consecutive ED and b) characterize potential targets for a standardized and reproducible model of HS-induced endotheliopathy in rats. METHODS: Rats were subjected to either a volume controlled HS (40% of total blood volume: v-HS group) or to a lab guided HS (l-HS) targeting base deficit (BD) >5...
July 10, 2017: Shock
https://www.readbyqxmd.com/read/28693536/hypothermia-induced-alteration-of-repolarization-impact-on-acute-and-long-term-outcome-a-prospective-cohort-study
#14
Sophie von Ulmenstein, Christian Storm, Thomas G K Breuer, Sebastian Lask, Philipp Attanasio, Andreas Mügge, Alexander Wutzler
BACKGROUND: The effects of target temperature management (TTM) on the heart aren't thoroughly studied yet. Several studies showed the prolongation of various ECG parameters including Tpeak-Tend-time under TTM. Our study's goal is to evaluate the acute and long-term outcome of these prolongations. METHODS: In this study we included patients with successful resuscitation after cardiac arrest who were admitted to the Charité Virchow Klinikum Berlin or the Heart and Vascular Centre of the Ruhr University Bochum between February 2006 and July 2013 (Berlin) or May 2014 to November 2015 (Bochum)...
July 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28682837/closed-loop-and-decision-assist-guided-fluid-therapy-of-human-hemorrhage
#15
Gabriel Hundeshagen, George C Kramer, Nicole Ribeiro Marques, Michael G Salter, Aristides K Koutrouvelis, Husong Li, Daneshvari R Solanki, Alexander Indrikovs, Roger Seeton, Sheryl N Henkel, Michael P Kinsky
OBJECTIVES: We sought to evaluate the efficacy, efficiency, and physiologic consequences of automated, endpoint-directed resuscitation systems and compare them to formula-based bolus resuscitation. DESIGN: Experimental human hemorrhage and resuscitation. SETTING: Clinical research laboratory. SUBJECTS: Healthy volunteers. INTERVENTIONS: Subjects (n = 7) were subjected to hemorrhage and underwent a randomized fluid resuscitation scheme on separate visits 1) formula-based bolus resuscitation; 2) semiautonomous (decision assist) fluid administration; and 3) fully autonomous (closed loop) resuscitation...
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28650929/oxygen-flow-pressure-targets-for-resuscitation-in-critical-hemodynamic-therapy
#16
Huaiwu He, Yun Long, Xiang Zhou, Xiaoting Wang, Hongmin Zhang, Wenzhao Chai, Na Cui, Hao Wang, Dawei Liu
Far from traditional "vital signs," the field of hemodynamic monitoring is developing rapidly. However, it is also easy to misunderstand hemodynamic therapy as merely hemodynamic monitoring and some concrete bundles or guidelines for circulation support. Here, we describe the concept of "critical hemodynamic therapy (CHT)" and clarify the concepts of the "therapeutic target" and "therapeutic endpoint" in clinical practice.Three main targets (Oxygen Delivery - Blood Flow - Perfusion Pressure, OFP) for resuscitation are reviewed in critically ill patients according to the sepsis guidelines and hemodynamic consensus...
June 23, 2017: Shock
https://www.readbyqxmd.com/read/28629995/intraosseous-compared-to-intravenous-drug-resuscitation-in-out-of-hospital-cardiac-arrest
#17
Bryan A Feinstein, Benjamin A Stubbs, Tom Rea, Peter J Kudenchuk
AIMS: Although the intraosseous (IO) route is increasingly used for vascular access in out-of-hospital cardiac arrest (OHCA), little is known about its comparative effectiveness relative to intravenous (IV) access. We evaluated clinical outcomes following OHCA comparing drug administration via IO versus IV routes. METHODS: This retrospective cohort study evaluated Emergency Medical Services (EMS)-treated adults with atraumatic OHCA in a large metropolitan EMS system between 9/1/2012-12/31/2014...
August 2017: Resuscitation
https://www.readbyqxmd.com/read/28577679/the-effects-of-sacubitril-valsartan-on-coronary-outcomes-in-paradigm-hf
#18
RANDOMIZED CONTROLLED TRIAL
Ulrik M Mogensen, Lars Køber, Søren L Kristensen, Pardeep S Jhund, Jianjian Gong, Martin P Lefkowitz, Adel R Rizkala, Jean L Rouleau, Victor C Shi, Karl Swedberg, Michael R Zile, Scott D Solomon, Milton Packer, John J V McMurray
BACKGROUND: Angiotensin converting enzyme inhibitors (ACE-I), are beneficial both in heart failure with reduced ejection fraction (HF-REF) and after myocardial infarction (MI). We examined the effects of the angiotensin-receptor neprilysin inhibitor sacubitril/valsartan, compared with the ACE-I enalapril, on coronary outcomes in PARADIGM-HF. METHODS AND RESULTS: We examined the effect of sacubitril/valsartan compared with enalapril on the following outcomes: i) the primary composite endpoint of cardiovascular (CV) death or HF hospitalization, ii) a pre-defined broader composite including, in addition, MI, stroke, and resuscitated sudden death, and iii) a post hoc coronary composite of CV-death, non-fatal MI, angina hospitalization or coronary revascularization...
June 2017: American Heart Journal
https://www.readbyqxmd.com/read/28577069/prevention-of-acute-kidney-injury-and-protection-of-renal-function-in-the-intensive-care-unit-update-2017-expert-opinion-of-the-working-group-on-prevention-aki-section-european-society-of-intensive-care-medicine
#19
M Joannidis, W Druml, L G Forni, A B J Groeneveld, P M Honore, E Hoste, M Ostermann, H M Oudemans-van Straaten, M Schetz
BACKGROUND: Acute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity. OBJECTIVES: To determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles. METHOD: A systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI...
June 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28555810/reduced-right-ventricular-diameter-during-cardiac-arrest-caused-by-tension-pneumothorax-a-porcine-ultrasound-study
#20
P Caap, R Aagaard, E Sloth, B Løfgren, A Granfeldt
INTRODUCTION: Advanced life support (ALS) guidelines recommend ultrasound to identify reversible causes of cardiac arrest. Right ventricular (RV) dilatation during cardiac arrest is commonly interpreted as a sign of pulmonary embolism. The RV is thus a focus of clinical ultrasound examination. Importantly, in animal studies ventricular fibrillation and hypoxia results in RV dilatation. Tension pneumothorax (tPTX) is another reversible cause of cardiac arrest, however, the impact on RV diameter remains unknown...
August 2017: Acta Anaesthesiologica Scandinavica
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