The sounds of cardiac arrest: innovating to obtain an accurate record during in-hospital cardiac arrest

BACKGROUND

To obtain an accurate audit during in-hospital cardiac arrest, following recommendations of the Utstein style and measuring time intervals between the different interventions, is difficult.

OBJECTIVE

To assess whether the use of an audio recording system during in-hospital cardiac arrest resuscitation allows the register of more items during cardiopulmonary resuscitation.

MATERIAL AND METHODS

Prospective observational study between January 2008 and December 2009. The population that were included, were hospitalized patients and non-hospitalized patients assisted by a cardiac arrest team, except for critical areas. An audio recording system with a timer was turned on when cardiac arrest team was alerted. Recordings were reviewed to fill in the items recommended by the Utstein style. Time intervals were calculated. Mean number of completed items per patient were compared between recorded and non-recorded cardiac arrest.

RESULTS

119 CA team alerts took place. 64 (53.7%) cases were real CA and 37 (57.8%) of them were properly recorded. A mean number of items per patient in recorded cardiac arrest cases were 18.18 (±3.2) vs. 15.96 (±4.1) in non-recorded cardiac arrest cases (p<0.05). In the recorded cases, mean times were: alert - arrival: 1.23 (±0.95)min; arrival - cardiopulmonary resuscitation initiation: 0.63 (±0.38)min; arrival - first defibrillation: 2.06 (±1.33)min; arrival - intubation: 8.42 (±4.64)min; arrival - first adrenaline: 3.30 (±1.98)min.

CONCLUSIONS

The audio recording system permits the register of a larger number of items per patient during in-hospital cardiac arrest and allows measurement of time intervals between the different interventions during cardiopulmonary resuscitation.

High-flow nasal therapy in adults with severe acute respiratory infection: a cohort study in patients with 2009 influenza A/H1N1v

PURPOSE

The experience with high-flow nasal cannula (HFNC) oxygen therapy in severe acute respiratory infection (SARI) is limited. The objective was to assess the effectiveness of HFNC oxygen therapy in adult patients with SARI by confirmed 2009 influenza A/H1N1v infection (by real-time reverse transcription polymerase chain reaction testing).

MATERIAL AND METHODS

A single-center post hoc analysis of a cohort of intensive care unit patients admitted with SARI due to 2009 Influenza A/H1N1v was done. High-flow nasal cannula (Optiflow; Fisher & Paykel, Auckland, New Zealand) was indicated in the presence of acute respiratory failure when the patient was unable to maintain a pulse oxymetry more than 92% with more than 9 L/min of oxygen using a standard face mask conventional delivery systems. Nonresponders were defined by their need of subsequent mechanical ventilation.

RESULTS

Twenty-five nonintubated adult patients were admitted for SARI (21 pneumonia). Twenty were unable to maintain pulse oxymetry more than 92% with conventional oxygen administration and required HFNC O(2) therapy, which was successful in 9 (45%). All 8 patients on vasopressors required intubation within 24 hours. After 6 hours of HFNC O(2) therapy, nonresponders presented a lower Pao(2)/fraction of inspired oxygen (median, 135 [interquartile range, 84-210] vs 73 [56-81] mm Hg P < .05) and needed higher oxygen flow rate. No secondary infections were reported in health care workers. No nosocomial pneumonia occurred during HFNC O(2) therapy.

CONCLUSION

High-flow nasal cannula O(2) therapy appears to be an innovative and effective modality for early treatment of adults with SARI.

Behavioral differentiation during collective building in wild mice Mus spicilegus

Although well documented in social insects, the possibility of behavioral differentiation during collective building has been poorly studied in mammals. In this context, the mound-building mouse Mus spicilegus is an interesting model. Under natural conditions, juveniles from different litters gather vegetal material and build a sophisticated structure, the mound, under which the mice will spend winter. The first steps of this complex building process may be elicited under laboratory conditions by offering cotton balls as building material. Spatio-temporal distribution of both animals and cotton balls was automatically recorded by RFID (Radio-Frequency Identification Device) technique. Our results revealed a behavioral differentiation during a collective building task. In a group of six individuals, only two mice (called carriers) transported 80% of the building material whereas the contribution of the remaining mice was weak or even non-existent. The proportion of carriers was constant in all of the six groups studied. This behavioral differentiation was implemented immediately after the building material was made available and remained stable during the 4 days of experiment. The high contribution level of carriers did not result from resource monopolization, nor did it depend on the gender or parental origin of the mice.

Bio-inspired porous SiC ceramics loaded with vancomycin for preventing MRSA infections

Implant-related infections are a serious complication in orthopaedic and dental surgery resulting in prolonged hospitalization, high medical costs and patient mortality. The development of porous implants loaded with antibiotics may enable a local delivery for preventing surface colonization and biofilm formation. A new generation of bio-derived porous ceramic material that mimics hierarchical structures from Nature was evaluated. Silicon carbide ceramics derived from Sapelli wood (bioSiC) were obtained by pyrolysis of Entandrophragma cylindricum wood followed by infiltration with molten silicon. This process renders disks that keep the bimodal pore size distribution (3 and 85 μm) of the original material and are highly cytocompatible (BALB/3T3 cell line). The ability of the bio-ceramic to load the antimicrobial agent vancomycin was evaluated by immersion of disks in drug solutions covering a wide range of concentrations. The disks released at pH 7.4 an important amount of drug during the first 2 h (up to 11 mg/g bioSiC) followed by a slower release, which is related to the presence of macro- and mesopores. Finally, the anti-biofilm effect against methicillin resistant Staphylococcus aureus was assessed and a considerable reduction (92%) of the bacterial film was observed. Results highlight the bioSiC potential as component of medicated medical devices.