151
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Kuwahara M, Otagaki H, Imanaka H. Pneumatosis Intestinalis With Abdominal Wall Emphysema in Hypothermia. Cureus 2023; 15:e34909. [PMID: 36938220 PMCID: PMC10016734 DOI: 10.7759/cureus.34909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/15/2023] Open
Abstract
In this report, we present a case in which intestinal and abdominal wall emphysema was observed, but the patient was unconscious due to hypothermia, making it difficult to determine the indication for surgery. Pneumatosis intestinalis (PI) is a pathological condition characterized by the presence of gas within the walls of the small or large intestine and is considered a surgical emergency when accompanied by manifestations of peritonitis on abdominal examination, metabolic acidosis, and lactic acid levels above 2.0 mmol/L. In this specific case, the patient's blood draw results indicated the requirement for an emergency laparotomy; however, the patient's unconscious state became a challenge to make decision on informed consenting. The case illustrates the difficulties encountered in making treatment decisions in critically ill patients and the necessity for thorough assessments and close monitoring of vital signs in such patients.
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Affiliation(s)
- Masaatsu Kuwahara
- Department of Emergency Medicine, Takarazuka City Hospital, Takarazuka, JPN
| | - Hiroko Otagaki
- Department of Emergency Medicine, Takarazuka City Hospital, Takarazuka, JPN
| | - Hideaki Imanaka
- Department of Emergency Medicine, Takarazuka City Hospital, Takarazuka, JPN
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152
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Weber S, Kulla M, Lechner R. Herz-Kreislauf-Stillstand im alpinen Gelände. FLUGMEDIZIN · TROPENMEDIZIN · REISEMEDIZIN - FTR 2023. [DOI: 10.1055/a-2003-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ZUSAMMENFASSUNGDie Anzahl von Touristen und Freizeitsportlern in Bergregionen nimmt zu. Im Verhältnis dazu steigt auch die Zahl an Notfallsituationen wie Herz-Kreislauf-Stillstand. Wiederbelebungsmaßnahmen in diesen Umgebungsbedingungen sind anspruchsvoll. Eine besondere Bedeutung in diesem Rahmen hat die prolongierte kardiopulmonale Reanimation.
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Affiliation(s)
- Sebastian Weber
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Martin Kulla
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Raimund Lechner
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
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153
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Affiliation(s)
- John F Keaney
- From Brigham and Women's Hospital, Boston (J.F.K.); and the University Medical Center Mainz, Mainz, Germany (T.M.)
| | - Thomas Münzel
- From Brigham and Women's Hospital, Boston (J.F.K.); and the University Medical Center Mainz, Mainz, Germany (T.M.)
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154
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Hardeland C, Svendsen EJ, Heitmann GB, Leonardsen AL. Healthcare personnel self-assessed competence and knowledge following implementation of a new guideline on maternal resuscitation in Norway. A repeated measure study. Health Sci Rep 2023; 6:e1035. [PMID: 36698715 PMCID: PMC9847399 DOI: 10.1002/hsr2.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Cardiac arrest in pregnancy is a rare, yet extremely challenging condition to manage for all healthcare personnel involved. Knowledge deficits and poor resuscitation skills can affect outcomes in cardiac arrest in pregnancy, but research exploring healthcare personnel competence and knowledge about maternal resuscitation is limited. Aims The aim of this study was to explore (1) healthcare personnel self-assessed competence and knowledge about cardiopulmonary resuscitation (CPR) in pregnancy as well as perimortem caesarean section, before and after implementation of a new guideline, (2) whether there were any interprofessional differences in knowledge about maternal resuscitation, and (3) potential differences between different implementation strategies. Research Methodology The study had a prospective repeated measure implementation design, utilizing a questionnaire before and after implementation of a new guideline on maternal resuscitation after cardiac arrest. Setting All healthcare personnel potentially involved in CPR in six hospital wards, were invited to participate (n = 527). The guideline was implemented through either simulation, table-top discussions and/or an electronical learning course. Results In total, 251 (48%) participants responded to the pre-questionnaire, and 182 (35%) to the postquestionnaire. The need for education and training/simulation concerning maternal resuscitation were significantly lowered after implementation of the guideline, yet still the majority of respondents reported a high to medium need for education and training/simulation. Participants' self-assessed overall competence in maternal resuscitation increased significantly postimplementation. Regardless of professional background, knowledge about CPR and perimortem caesarean section increased significantly in most items in the questionnaire after implementation. Differences in level of knowledge based on implementation strategy was identified, but varied between items, and was therefore inconclusive. Conclusion This study adds knowledge about healthcare personnel self-assessed competence and knowledge about maternal resuscitation and perimortem caesarean section in pregnancy. Our findings indicate that there is still a need for more education and training in this rare incident.
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Affiliation(s)
- Camilla Hardeland
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway
| | - Edel J. Svendsen
- Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway,Department of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway,Department of ResearchSunnaas Rehabilitation HospitalBjørnemyrNorway
| | | | - Ann‐Chatrin L. Leonardsen
- Faculty of Health, Welfare and OrganisationØstfold University CollegeHaldenNorway,Department of AnesthesiologyØstfold Hospital TrustSarpsborgNorway
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155
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Chiu M, Garg AX, Moist L, Jain AK. A New Perspective to Longstanding Challenges with Outpatient Hyperkalemia: A Narrative Review. Can J Kidney Health Dis 2023; 10:20543581221149710. [PMID: 36654931 PMCID: PMC9841831 DOI: 10.1177/20543581221149710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose of Review Outpatient hyperkalemia is a common problem with potentially deadly consequences. Potassium level thresholds to treat outpatient hyperkalemia are unstandardized and variable, leaving health care providers to rely on their own clinical judgment. This narrative review highlights the challenges of outpatient hyperkalemia management and includes recommendations for future studies that may standardize treatment, improve patient outcomes, and optimize health care utilization. Sources of Information PubMed, Google Scholar, and the reference lists of identified articles were used to include English, peer-reviewed studies and guidelines for this review. Methods This narrative review examines outpatient hyperkalemia from both a laboratory and clinical perspective. In addition to peer-reviewed literature, guidelines and expert consensus statements were included to highlight the inconsistencies and paucity of evidence that health care providers rely on to make clinical decisions. Key Findings There are multiple reasons why outpatient hyperkalemia management is both challenging and sub-optimal. Clinicians must discern if the potassium level result is accurate and, if so, does the result warrant referral to the emergency department. Factitious hyperkalemia, or falsely elevated potassium level results due to analytical errors, occurs frequently, but there are no ways to identify it other than for hemolyzed samples. Additionally, guidelines and expert panels are inconsistent on the thresholds for treatment and the management of hyperkalemia. Finally, there are inconsistencies between laboratories as to when and how providers are notified of results, and the suggested thresholds for urgent management. A study that integrates the expertise of clinical biochemists and clinicians is needed to inform evidence-based guidelines for the management of outpatient hyperkalemia. Limitations This was a comprehensive review of what is known and what still needs to be understood for the management of outpatient hyperkalemia. A formal tool to assess the quality of the included studies was not used and selection bias may have occurred.
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Affiliation(s)
- Michael Chiu
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Michael Chiu, Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, 800 Commissioners Rd E, Room A2-342 London, ON N6A 5W9 Canada.
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Department of Clinical Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Louise Moist
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Department of Clinical Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Arsh K. Jain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Department of Clinical Epidemiology and Biostatistics, Western University, London, ON, Canada
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156
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Tomas N, Kachekele ZA. Nurses' Knowledge, Attitudes, and Practice of Cardiopulmonary Resuscitation at a Selected Training Hospital in Namibia: A Cross-Sectional Survey. SAGE Open Nurs 2023; 9:23779608231216809. [PMID: 38020323 PMCID: PMC10676069 DOI: 10.1177/23779608231216809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Nurses play a key role in cases of cardiopulmonary arrest by promptly attending to and initiating cardiopulmonary resuscitation. Effective cardiopulmonary resuscitation thus requires nurses to possess appropriate attitudes, competencies, and adherence to the best nursing practice. Cardiac arrests are a prevalent cause of fatalities, being responsible for approximately 30% of deaths worldwide. Despite this statistic, however, research in this specific field is lacking in Namibia. Objective The objective of this research was to examine registered nurses' knowledge, attitudes toward, and practice with regard to cardiopulmonary resuscitation at a selected teaching hospital in Namibia. Methods A cross-sectional survey design using a self-administered questionnaire was utilized to purposively recruit 158 registered nurses from the inpatient and outpatient departments of a teaching hospital in Namibia. Descriptive and chi-square tests were performed using SPSSv26. Results The results of the study indicate that a significant percentage of nurses have limited knowledge (14.7 ± 1.50), negative attitudes (36.2 ± 4.8), and poor practice (11.16 ± 1.18) when it comes to cardiopulmonary resuscitation. Their poor knowledge is strongly associated with poor practice (χ2 = 9.162, P = .002). The study further revealed a significant correlation between the departments in which the nurses worked and their practice of cardiopulmonary resuscitation, suggesting that the work environment is a crucial factor in determining a nurse's approach to emergency care. Conclusion The findings of study indicate that the cardiopulmonary resuscitation practice in the selected hospital is unsafe due to the registered nurses' poor knowledge and negative attitudes. It is strongly recommended that hospital managers and policy-makers take steps to formulate guidelines that mandate regular cardiopulmonary resuscitation training at predetermined times.
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Affiliation(s)
- Nestor Tomas
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, School of Nursing and Public Health, University of Namibia (UNAM), Rundu, Namibia
| | - Zuze A. Kachekele
- Department of General Nursing Science, Faculty of Health Sciences and Veterinary Medicine, School of Nursing and Public Health, University of Namibia (UNAM), Rundu, Namibia
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157
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Prekker ME, Rischall M, Carlson M, Driver BE, Touroutoutoudis M, Boland J, Hu M, Heather B, Simpson NS. Extracorporeal membrane oxygenation versus conventional rewarming for severe hypothermia in an urban emergency department. Acad Emerg Med 2023; 30:6-15. [PMID: 36000288 DOI: 10.1111/acem.14585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/28/2022] [Accepted: 08/19/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Severe hypothermia (core body temperature < 28°C) is life-threatening and predisposes to cardiac arrest. The comparative effectiveness of different active internal rewarming methods in an urban U.S. population is unknown. We aim to compare outcomes between hypothermic emergency department (ED) patients rewarmed conventionally using an intravascular rewarming catheter or warm fluid lavage versus those rewarmed using extracorporeal membrane oxygenation (ECMO). METHODS We performed a retrospective cohort analysis of adults with severe hypothermia due to outdoor exposure presenting to an urban ED in Minnesota, 2007-2021. The primary outcome was hospital survival. We also calculated the rewarming rate in the 4 h after ED arrival and compared these data between patients rewarmed with ECMO (the extracorporeal rewarming group) versus without ECMO (the conventional rewarming group). We repeated these analyses in the subgroup of patients with cardiac arrest. RESULTS We analyzed 44 hypothermic ED patients: 25 patients in the extracorporeal rewarming group (median temperature 24.1°C, 84% with cardiac arrest) and 19 patients in the conventional rewarming group (median temperature 26.3°C, 37% with cardiac arrest; 89% received an intravascular rewarming catheter). The median rewarming rate was greater in the extracorporeal versus conventional group (2.3°C/h vs. 1.5°C/h, absolute difference 0.8°C/h, 95% confidence interval [CI] 0.3-1.2°C/h) yet hospital survival was similar (68% vs. 74%). Among patients with cardiac arrest, hospital survival was greater in the extracorporeal versus conventional group (71% vs. 29%, absolute difference 42%, 95% CI 4%-82%). CONCLUSIONS Among ED patients with severe hypothermia and cardiac arrest, survival was significantly higher with ECMO versus conventional rewarming. Among all hypothermic patients, ECMO use was associated with faster rewarming than conventional methods.
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Affiliation(s)
- Matthew E Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.,Division of Pulmonary and Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Megan Rischall
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Michelle Carlson
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | | | - Jessica Boland
- Department of Critical Care Medicine, Allina Health, Minneapolis, Minnesota, USA
| | - Michael Hu
- Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Beth Heather
- Critical Care Nursing and the Extracorporeal Life Support Program, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Nicholas S Simpson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.,Hennepin Emergency Medical Services, Minneapolis, Minnesota, USA
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158
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Walji HD, Ellis SA, Martin-Ucar AE, Hernandez L. Simulation in thoracic surgery-A mini review of a vital educational tool to maximize peri-operative care and minimize complications. Front Surg 2023; 10:1146716. [PMID: 37206340 PMCID: PMC10189136 DOI: 10.3389/fsurg.2023.1146716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
Thoracic surgery is an increasingly expanding field, and the addition of national screening programs has resulted in increasing operative numbers and complexity. Thoracic surgery overall has an approximately 2% mortality and 20% morbidity with common specific complications including persistent air leak, pneumothorax, and fistulas. The nature of the surgery results in complications being unique to thoracic surgery and often very junior members of the surgical team feel underprepared to deal with these complications after very little exposure during their medical school and general surgical rotations. Throughout medicine, simulation is being increasingly used as a method to teach the management of complicated, rare, or significant risk occurrences and has shown significant benefits in learner confidence and outcomes. In this mini review we explain the learning theory and benefits of simulation learning. We also discuss the current state of simulation in thoracic surgery and its potential future in aiding complication management and patient safety.
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Affiliation(s)
- Hasanali David Walji
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Steven Aaron Ellis
- Department of Medical Education, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Antonio Eduardo Martin-Ucar
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Luis Hernandez
- Department of Cardio-Thoracic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
- Correspondence: Luis Hernandez
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159
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Takauji S, Hayakawa M, Yamada D, Tian T, Minowa K, Inoue A, Fujimoto Y, Isokawa S, Miura N, Endo T, Irie J, Otomo G, Sato H, Bando K, Suzuki T, Toyohara T, Tomita A, Iwahara M, Murata S, Shimazaki J, Matsuyoshi T, Yoshizawa J, Nitta K, Sato Y. Outcome of extracorporeal membrane oxygenation use in severe accidental hypothermia with cardiac arrest and circulatory instability: A multicentre, prospective, observational study in Japan (ICE-CRASH study). Resuscitation 2023; 182:109663. [PMID: 36509361 DOI: 10.1016/j.resuscitation.2022.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
AIM To elucidate the effectiveness of extracorporeal membrane oxygenation (ECMO) in accidental hypothermia (AH) patients with and without cardiac arrest (CA), including details of complications. METHODS This study was a multicentre, prospective, observational study of AH in Japan. All adult (aged ≥18 years) AH patients with body temperature ≤32 °C who presented to the emergency department between December 2019 and March 2022 were included. Among the patients, those with CA or circulatory instability, defined as severe AH, were selected and divided into the ECMO and non-ECMO groups. We compared 28-day survival and favourable neurological outcomes at discharge between the ECMO and non-ECMO groups by adjusting for the patients' background characteristics using multivariable logistic regression analysis. RESULTS Among the 499 patients in this study, 242 patients with severe AH were included in the analysis: 41 in the ECMO group and 201 in the non-ECMO group. Multivariable analysis showed that the ECMO group was significantly associated with better 28-day survival and favourable neurological outcomes at discharge in patients with CA compared to the non-ECMO group (odds ratio [OR] 0.17, 95% confidence interval [CI]: 0.05-0.58, and OR 0.22, 95%CI: 0.06-0.81). However, in patients without CA, ECMO not only did not improve 28-day survival and neurological outcomes, but also decreased the number of event-free days (ICU-, ventilator-, and catecholamine administration-free days) and increased the frequency of bleeding complications. CONCLUSIONS ECMO improved survival and neurological outcomes in AH patients with CA, but not in AH patients without CA.
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Affiliation(s)
- Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University Hospital, Asahikawa, Japan.
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Yamada
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Tian Tian
- Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Keita Minowa
- Department of Emergency and Critical Care Medicine, Hachinohe City Hospital, Hachinohe, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Yoshihiro Fujimoto
- Department of Emergency Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Naoya Miura
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Tokai, Japan
| | - Tomoyuki Endo
- Department of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Jin Irie
- Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Japan
| | - Gen Otomo
- Emergency and Critical Care Medicine, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Hiroki Sato
- Critical Care and Emergency Center National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Keisuke Bando
- Department of Emergency Medicine and Critical Care, Sapporo City General Hospital, Sapporo, Japan
| | - Tsuyoshi Suzuki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Takashi Toyohara
- Department of Emergency Medicine, Kushiro City General Hospital, Kushiro, Japan
| | - Akiko Tomita
- Department of Emergency Medicine, Sunagawa City Medical Center, Sunagawa, Japan
| | - Motoko Iwahara
- Department of Emergency Medicine, Nayoro City General Hospital, Nayoro, Japan
| | - Satoru Murata
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeo Matsuyoshi
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Jo Yoshizawa
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenichi Nitta
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Sato
- Emergency and Critical Care Center, Aomori Prefectural Central Hospital, Aomori, Japan
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160
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Fijačko N, Nolan JP, Štiglic G, Kocbek P, Greif R. Content analysis of Twitter users' responses to the crowd crush tragedy in Seoul, South Korea in October 2022. Resuscitation 2023; 182:109658. [PMID: 36481239 DOI: 10.1016/j.resuscitation.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Nino Fijačko
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; ERC Research Net, Niels, Belgium. https://twitter.com/ninofijacko
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Gregor Štiglic
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia; University of Maribor, Faculty of Electrical Engineering and Computer Science, Maribor, Slovenia; University of Edinburgh, Usher Institute, Edinburgh, United Kingdom
| | - Primož Kocbek
- University of Maribor, Faculty of Health Sciences, Maribor, Slovenia
| | - Robert Greif
- ERC Research Net, Niels, Belgium; University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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161
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Katzenschlager S, Obermaier M, Kuhner M, Spöttl W, Dietrich M, Weigand MA, Weilbacher F, Popp E. [Focus on emergency medicine 2021/2022-Summary of selected emergency medicine studies]. DIE ANAESTHESIOLOGIE 2023; 72:130-142. [PMID: 36602555 PMCID: PMC9813891 DOI: 10.1007/s00101-022-01245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Affiliation(s)
- S. Katzenschlager
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Obermaier
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Kuhner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - W. Spöttl
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Dietrich
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. A. Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - F. Weilbacher
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - E. Popp
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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162
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Lazzarin T, Tonon CR, Martins D, Fávero EL, Baumgratz TD, Pereira FWL, Pinheiro VR, Ballarin RS, Queiroz DAR, Azevedo PS, Polegato BF, Okoshi MP, Zornoff L, Rupp de Paiva SA, Minicucci MF. Post-Cardiac Arrest: Mechanisms, Management, and Future Perspectives. J Clin Med 2022; 12:jcm12010259. [PMID: 36615059 PMCID: PMC9820907 DOI: 10.3390/jcm12010259] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Cardiac arrest is an important public health issue, with a survival rate of approximately 15 to 22%. A great proportion of these deaths occur after resuscitation due to post-cardiac arrest syndrome, which is characterized by the ischemia-reperfusion injury that affects the role body. Understanding physiopathology is mandatory to discover new treatment strategies and obtain better results. Besides improvements in cardiopulmonary resuscitation maneuvers, the great increase in survival rates observed in recent decades is due to new approaches to post-cardiac arrest care. In this review, we will discuss physiopathology, etiologies, and post-resuscitation care, emphasizing targeted temperature management, early coronary angiography, and rehabilitation.
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163
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Ippolito M, Tubiolo M, Falletta A, Federico A, Simone B, Ingoglia G, Gregoretti C, Raineri SM, Cortegiani A, Giarratano A. Cardiac arrest during a diving session: A case report and differential diagnosis. Clin Case Rep 2022; 10:e6805. [PMID: 36590666 PMCID: PMC9795086 DOI: 10.1002/ccr3.6805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/29/2022] Open
Abstract
We report a case of out-of-hospital cardiac arrest occurred in a 61-year-old recreational female diver. After resuscitation, the patient was referred to the hospital. With data provided by witnesses and appropriate medical investigations, drowning related to a failed rebreather system was the most plausible explanation. Patient outcome was favorable.
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Affiliation(s)
- Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly,Department of Anaesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconePalermoItaly
| | - Martina Tubiolo
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly
| | - Angelo Falletta
- Pronto Soccorso con O.B.I.Policlinico Paolo GiacconePalermoItaly
| | - Antonino Federico
- Department of Anaesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconePalermoItaly
| | - Barbara Simone
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly
| | - Giulia Ingoglia
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly,Department of Anaesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconePalermoItaly
| | - Cesare Gregoretti
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly,Fondazione Gemelli‐GiglioCefalùItaly
| | - Santi Maurizio Raineri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly,Department of Anaesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconePalermoItaly
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly,Department of Anaesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconePalermoItaly
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.)University of PalermoPalermoItaly,Department of Anaesthesia, Intensive Care and EmergencyPoliclinico Paolo GiacconePalermoItaly
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Škulec R. Year 2022 in review - Pre-hospital emergency care. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Selli AL, Kuzmiszyn AK, Smaglyukova N, Kondratiev T, Fuskevåg OM, Sager G, Dietrichs ES. Pharmacodynamic properties for inhibition of cAMP- and cGMP elimination by pentoxifylline remain unaltered in vitro during hypothermia. Scand J Trauma Resusc Emerg Med 2022; 30:73. [PMID: 36522632 PMCID: PMC9756503 DOI: 10.1186/s13049-022-01060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Rewarming from hypothermia is associated with severe complications, one of which is hypothermia-induced cardiac dysfunction. This condition is characterized by decreased cardiac output accompanied by increased total peripheral resistance. This contributes to mortality rate approaching 40%. Despite this, no pharmacological interventions are recommended for these patients below 30 °C. Raising the intracellular levels of cAMP and/or cGMP, through PDE3- and PDE5-inhibitors respectively, have showed the ability to alleviate hypothermia-induced cardiac dysfunction in vivo. Drugs that raise levels of both cAMP and cGMP could therefore prove beneficial in patients suffering from hypothermia-induced cardiac dysfunction. METHODS The unselective PDE-inhibitor pentoxifylline was investigated to determine its ability to reach the intracellular space, inhibit PDE3 and PDE5 and inhibit cellular efflux of cAMP and cGMP at temperatures 37, 34, 30, 28, 24 and 20 °C. Recombinant human PDE-enzymes and human erythrocytes were used in the experiments. IC50-values were calculated at all temperatures to determine temperature-dependent changes. RESULTS At 20 °C, the IC50-value for PDE5-mediated enzymatic breakdown of cGMP was significantly increased compared to normothermia (IC50: 39.4 µM ± 10.9 µM vs. 7.70 µM ± 0.265 µM, p-value = 0.011). No other significant changes in IC50-values were observed during hypothermia. CONCLUSIONS This study shows that pentoxifylline has minimal temperature-dependent pharmacodynamic changes, and that it can inhibit elimination of both cAMP and cGMP at low temperatures. This can potentially be effective treatment of hypothermia-induced cardiac dysfunction. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Anders Lund Selli
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Adrina Kalasho Kuzmiszyn
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.420120.50000 0004 0481 3017Research and Development Department, Norwegian Air Ambulance Foundation, Oslo, Norway ,grid.412244.50000 0004 4689 5540Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Natalia Smaglyukova
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Timofey Kondratiev
- grid.10919.300000000122595234Anesthesia and Critical Care Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ole-Martin Fuskevåg
- grid.412244.50000 0004 4689 5540Division of Diagnostic Services, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Georg Sager
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Erik Sveberg Dietrichs
- grid.10919.300000000122595234Department of Medical Biology, Experimental and Clinical Pharmacology, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.413684.c0000 0004 0512 8628Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
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Natural Taxanes: From Plant Composition to Human Pharmacology and Toxicity. Int J Mol Sci 2022; 23:ijms232415619. [PMID: 36555256 PMCID: PMC9779243 DOI: 10.3390/ijms232415619] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Biologically active taxanes, present in small- to medium-sized evergreen conifers of various Taxus species, are widely used for their antioxidant, antimicrobial and anti-inflammatory effects, but mostly for their antitumour effects used in the treatment of solid tumours of the breast, ovary, lung, bladder, prostate, oesophagus and melanoma. More of the substances found in Taxus plant extracts have medical potential. Therefore, at the beginning of this review, we describe the methods of isolation, identification and determination of taxanes in different plant parts. One of the most important taxanes is paclitaxel, for which we summarize the pharmacokinetic parameters of its different formulations. We also describe toxicological risks during clinical therapy such as hypersensitivity, neurotoxicity, gastrointestinal, cardiovascular, haematological, skin and renal toxicity and toxicity to the respiratory system. Since the effect of the drug-form PTX is enhanced by various Taxus spp. extracts, we summarize published clinical intoxications and all fatal poisonings for the Taxus baccata plant. This showed that, despite their significant use in anticancer treatment, attention should also be focused on the risk of fatal intoxication due to ingestion of extracts from these plants, which are commonly found in our surroundings.
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Advanced and Invasive Cardiopulmonary Resuscitation (CPR) Techniques as an Adjunct to Advanced Cardiac Life Support. J Clin Med 2022; 11:jcm11247315. [PMID: 36555932 PMCID: PMC9781548 DOI: 10.3390/jcm11247315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged for decades. Recently, technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situation. METHODS A selective literature search in the core databases with a focus on randomized controlled trials and guidelines. RESULTS Technical aids, such as feedback systems or automated mechanical cardiopulmonary resuscitation (CPR) devices, can improve chest compression quality. The latter, as well as extracorporeal CPR, might serve as a bridge to treatment (with extracorporeal CPR even as a bridge to recovery). Sonography may be used to improve thoracic compressions on the one hand and to rule out potentially reversible causes of cardiac arrest on the other. Resuscitative endovascular balloon occlusion of the aorta might enhance myocardial and cerebral perfusion. Minithoracostomy, pericardiocentesis, or clamshell thoracotomy might resolve reversible causes of cardiac arrest. CONCLUSIONS It is crucial to identify those patients who may benefit from an advanced or invasive procedure and make the decision to implement the intervention in a timely manner. As with all infrequently performed procedures, sound education and regular training are paramount.
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Rafique Z, Hoang B, Mesbah H, Pappal R, Peacock FW, Juarez-Vela R, Szarpak L, Kuo DC. Hyperkalemia and Electrocardiogram Manifestations in End-Stage Renal Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16140. [PMID: 36498212 PMCID: PMC9736513 DOI: 10.3390/ijerph192316140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Hyperkalemia is one of the more common acute life-threatening metabolic emergencies. The aim of our study is to determine the correlation and accuracy of abnormal ECG parameters as a function of serum potassium concentration in the end-stage renal disease (ESRD) population. We performed a retrospective chart review of emergency department patients presenting with ESRD and receiving emergent hemodialysis treatment. A total of 96 patients, each with five independent ED visits, provided 480 sets of ECGs and electrolytes. Of these, four ECGs were excluded for inability to interpret, leaving a total of 476 patient encounters that met all inclusion criteria. Linear regression analysis on the limited data set for serum potassium versus T/R in V2, V3, and V4, PR, and QRS found weak correlations (r2 = 0.02 to 0.12) with statistical significance <0.05 level for T/R in V2, V3, and V4. In summary, we found that a QRS duration of 120 ms or greater is most predictive of hyperkalemia in the ESRD population. On the other hand, T/R ratio, PR interval and QRS duration have poor correlations with serum potassium and are not predictive of hyperkalemia in patients with ESRD.
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Affiliation(s)
- Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bryan Hoang
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77004, USA
| | - Heba Mesbah
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Ryan Pappal
- Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Raul Juarez-Vela
- Group in Research in Care (GRUPAC), Department of Nursing, University of La Rioja, 93-103 Logrono, Spain
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dick C. Kuo
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Malysch T, Breuer F, Wolff J, Poloczek S, Dahmen J. Präklinische Notfallthorakotomie in der Berliner Notfallrettung – Darstellung der Umsetzung im Land Berlin und Diskussion erster Erkenntnisse. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ZusammenfassungIm Jahr 2015 fand das Thema „traumatisch bedingter Herz-Kreislauf-Stillstand“ erstmalig Einzug in die aktualisierten Reanimationsleitlinien des European Resuscitation Council. Neben dem speziell anzuwendenden Maßnahmenbündel mit Atemwegsmanagement, Therapie der Hypovolämie, externer Blutungskontrolle und beidseitiger Thoraxentlastung sollte auch eine Notfallthorakotomie bei geeigneten Patienten erwogen werden. Um dieses Vorgehen systematisch in der Berliner Notfallrettung zu etablieren und standardisieren, hat die Ärztliche Leitung Rettungsdienst der Berliner Feuerwehr verschiedene Maßnahmen unternommen, um die optimale Ausnutzung der Schlüsselfaktoren Expertise, „elapsed time“, Equipment und „environment“ sicherzustellen. Dabei konnten im Laufe der ersten 2,5 Jahre auch bereits wichtige Erfahrungen aus der neuen Versorgungsstruktur dieser schwerstverletzten Patienten gewonnen werden.
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Out-of-hospital cardiac arrest complicated by hyperthermia. Resusc Plus 2022; 12:100333. [DOI: 10.1016/j.resplu.2022.100333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
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Kane AD, Armstrong RA, Kursumovic E, Cook TM, Oglesby FC, Cortes L, Moppett IK, Moonesinghe SR, Agarwal S, Bouch DC, Cordingley J, Davies MT, Dorey J, Finney SJ, Kunst G, Lucas DN, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Samuel K, Scholefield BR, Smith JH, Varney L, Vindrola‐Padros C, Martin S, Wain EC, Kendall SW, Ward S, Drake S, Lourtie J, Taylor C, Soar J. Methods of the 7 th National Audit Project (NAP7) of the Royal College of Anaesthetists: peri-operative cardiac arrest. Anaesthesia 2022; 77:1376-1385. [PMID: 36111390 PMCID: PMC9826156 DOI: 10.1111/anae.15856] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 01/11/2023]
Abstract
Cardiac arrest in the peri-operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri-operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large-scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri-operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three-part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri-operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri-operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri-operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri-operative period began with the World Health Organization 'sign-in' checklist or first hands-on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri-operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies.
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Low-Flow Duration and Outcomes of Extracorporeal Cardiopulmonary Resuscitation in Adults With In-Hospital Cardiac Arrest: A Nationwide Inpatient Database Study*. Crit Care Med 2022. [DOI: 10.1097/ccm.0000000000005679 10.1097/ccm.0000000000005679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Effect of calcium in patients with pulseless electrical activity and electrocardiographic characteristics potentially associated with hyperkalemia and ischemia-sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation 2022; 181:150-157. [PMID: 36403820 DOI: 10.1016/j.resuscitation.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Calcium for Out-of-hospital Cardiac Arrest (COCA) trial was recently conducted and published. This pre-planned sub-study evaluated the effect of calcium in patients with pulseless electrical activity (PEA) including subgroup analyses based on electrocardiographic characteristics potentially associated with hyperkalemia and ischemia. METHODS Patients aged ≥ 18 years were included if they had a non-traumatic out-of-hospital cardiac arrest and received adrenaline. The trial drug consisted of calcium chloride (5 mmol) or saline placebo given after the first, and again after the second, dose of adrenaline for a maximum of two doses. This sub-study analyzed patients with PEA as their last known rhythm prior to receiving the trial drug. Outcomes were return of spontaneous circulation and survival at 30 days. RESULTS 104 patients were analyzed. In the calcium group, 9 patients (20 %) achieved return of spontaneous circulation vs 23 patients (39 %) in the placebo group (risk ratio 0.51; 95 %CI 0.26, 1.00). Subgroup analyses based on electrocardiographic characteristics potentially associated with hyperkalemia and ischemia showed similar results. At 30 days, 1 patient (2.2 %) was alive in the calcium group while 8 patients (13.6 %) were alive in the placebo group (risk ratio 0.16; 95 %CI 0.02, 1.26). CONCLUSION In adults with out-of-hospital cardiac arrest presenting with PEA, effect estimates suggested harm of calcium administration as compared to placebo but with wide confidence intervals. Results were consistent for patients with electrocardiographic characteristics potentially associated with hyperkalemia and ischemia. The results do not support calcium administration based strictly on electrocardiographic findings seen during out-of-hospital cardiac arrest.
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174
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Avellanas Chavala ML. Accidental hypothermia: New clinical classification with the swiss revised system. Med Intensiva 2022; 46:716-717. [PMID: 36376219 DOI: 10.1016/j.medine.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 06/16/2023]
Affiliation(s)
- M L Avellanas Chavala
- Médico Especialista en Medicina Intensiva; Profesor del Master en Medicina de Urgencia y Rescate en Montaña, Universidad de Zaragoza, Huesca, Spain.
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Irfan FB, Consunji RIGDJ, Peralta R, El-Menyar A, Dsouza LB, Al-Suwaidi JM, Singh R, Castrén M, Djärv T, Alinier G. Comparison of in-hospital and out-of-hospital cardiac arrest of trauma patients in Qatar. Int J Emerg Med 2022; 15:52. [PMID: 36114456 PMCID: PMC9479227 DOI: 10.1186/s12245-022-00454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cardiac arrests in admitted hospital patients with trauma have not been described in the literature. We defined “in-hospital cardiac arrest of a trauma” (IHCAT) patient as “cessation of circulatory activity in a trauma patient confirmed by the absence of signs of circulation or abnormal cardiac arrest rhythm inside a hospital setting, which was not cardiac re-arrest.” This study aimed to compare epidemiology, clinical presentation, and outcomes between in- and out-of-hospital arrest resuscitations in trauma patients in Qatar. It was conducted as a retrospective cohort study including IHCAT and out-of-hospital trauma cardiac arrest (OHTCA) patients from January 2010 to December 2015 utilizing data from the national trauma registry, the out-of-hospital cardiac arrest registry, and the national ambulance service database. Results There were 716 traumatic cardiac arrest patients in Qatar from 2010 to 2015. A total of 410 OHTCA and 199 IHCAT patients were included for analysis. The mean annual crude incidence of IHCAT was 2.0 per 100,000 population compared to 4.0 per 100,000 population for OHTCA. The univariate comparative analysis between IHCAT and OHTCA patients showed a significant difference between ethnicities (p=0.04). With the exception of head injury, IHCAT had a significantly higher proportion of localization of injuries to anatomical regions compared to OHTCA; spinal injury (OR 3.5, 95% CI 1.5–8.3, p<0.004); chest injury (OR 2.62, 95% CI 1.62–4.19, p<0.00), and abdominal injury (OR 2.0, 95% CI 1.0–3.8, p<0.037). IHCAT patients had significantly higher hypovolemia (OR 1.66, 95% CI 1.18–2.35, p=0.004), higher mean Glasgow Coma Scale (GCS) score (OR 1.4, 95% CI 1.3–1.6, p<0.00), and a greater proportion of initial shockable rhythm (OR 3.51, 95% CI 1.6–7.7, p=0.002) and cardiac re-arrest (OR 6.0, 95% CI 3.3–10.8, p=<0.00) compared to OHTCA patients. Survival to hospital discharge was greater for IHCAT patients compared to OHTCA patients (OR 6.3, 95% CI 1.3–31.2, p=0.005). Multivariable analysis for comparison after adjustment for age and gender showed that IHCAT was associated with higher odds of spinal injury, abdominal injury, higher pre-hospital GCS, higher occurrence of cardiac re-arrest, and better survival than for OHTCA patients. IHCAT patients had a greater proportion of anatomically localized injuries indicating solitary injuries compared to greater polytrauma in OHTCA. In contrast, OHTCA patients had a higher proportion of diffuse blunt non-localizable polytrauma injuries that were severe enough to cause immediate or earlier onset of cardiac arrest. Conclusion In traumatic cardiac arrest patients, IHCAT was less common than OHTCA and might be related to a greater proportion of solitary localized anatomical blunt injuries (head/abdomen/chest/spine). In contrast, OHTCA patients were associated with diffuse blunt non-localizable polytrauma injuries with increased severity leading to immediate cardiac arrest. IHCAT was associated with a higher mean GCS score and a higher rate of initial shockable rhythm and cardiac re-arrest, and improved survival rates.
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Hooper A, Nolan JP, Rees N, Walker A, Perkins GD, Couper K. Drug routes in out-of-hospital cardiac arrest: A summary of current evidence. Resuscitation 2022; 181:70-78. [PMID: 36309248 DOI: 10.1016/j.resuscitation.2022.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Recent evidence showing the clinical effectiveness of drug therapy in cardiac arrest has led to renewed interest in the optimal route for drug administration in adult out-of-hospital cardiac arrest. Current resuscitation guidelines support use of the intravenous route for intra-arrest drug delivery, with the intraosseous route reserved for patients in whom intravenous access cannot be established. We sought to evaluate current evidence on drug route for administration of cardiac arrest drugs, with a specific focus on the intravenous and intraosseous route. We identified relevant animal, manikin, and human studies through targeted searches of MEDLINE in June 2022. Across pre-hospital systems, there is wide variation in use of the intraosseous route. Early administration of cardiac arrest drugs is associated with improved patient outcomes. Challenges in obtaining intravenous access mean that the intraosseous access may facilitate earlier drug administration. However, time from administration to the central circulation is unclear with pharmacokinetic data limited mainly to animal studies. Observational studies comparing the effect of intravenous and intraosseous drug administration on patient outcomes are challenging to interpret because of resuscitation time bias and other confounders. To date, no randomised controlled trial has directly compared the effect on patient outcomes of intraosseous compared with intravenous drug administration in cardiac arrest. The International Liaison Committee on Resuscitation has described the urgent need for randomised controlled trials comparing the intravenous and intraosseous route in adult out-of-hospital cardiac arrest. Ongoing clinical trials will directly address this knowledge gap.
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Affiliation(s)
- Amy Hooper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Nigel Rees
- Pre-hospital Emergency Response Unit, Welsh Ambulance Services NHS Trust, St Asaph, UK; Institute of Life Sciences, Swansea University, Swansea, UK
| | - Alison Walker
- West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK; Department of Emergency Medicine, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Gavin D Perkins
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
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Low-Flow Duration and Outcomes of Extracorporeal Cardiopulmonary Resuscitation in Adults With In-Hospital Cardiac Arrest: A Nationwide Inpatient Database Study. Crit Care Med 2022; 50:1768-1777. [PMID: 36190237 DOI: 10.1097/ccm.0000000000005679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Although existing guidelines recommend commencing cannulation for extracorporeal cardiopulmonary resuscitation (ECPR) within 10-20 minutes of failed conventional resuscitation efforts for cardiac arrest, there is little supportive evidence. The present study aimed to determine the association of low-flow duration with survival-to-discharge rate in in-hospital cardiac arrest patients who received ECPR. DESIGN A nationwide retrospective cohort study analyzed a nationwide inpatient database in Japan. Low-flow duration was defined as the time interval from initiation of chest compression to termination of chest compression. We assessed the association between low-flow duration and survival-to-discharge rate by predicting estimates with covariate adjustment stratified by categories of low-flow duration. SETTING More than 1,600 acute-care hospitals in Japan. PATIENTS All in-hospital cardiac arrest patients greater than or equal to 18 years old who received ECPR during hospitalization from July 2010 to March 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 303,319 in-hospital cardiac arrest patients, 9,844 (3.2%) received ECPR in 697 hospitals during the study period and 9,433 were eligible in the study. The overall survival-to-discharge rate was 20.5% (1,932/9,433). The median low-flow duration was 26.0 minutes (interquartile range, 12.0-46.0 min) in the overall cohort. The highest and lowest estimated survival-to-discharge rates were 35.1% in the group with low-flow duration 0-5 minutes and 7.9% in the group with low-flow duration greater than 90 minutes. The estimated survival-to-discharge rate dropped sharply by about 20% during the first 35 minutes of low-flow duration (decreasing by about 3% every 5 min), followed by small decreases after the first 35 minutes. CONCLUSIONS The estimated survival-to-discharge rate was markedly decreased by approximately 20% during the first 35 minutes of low-flow duration. Whether we should wait for the first 10-20 minutes of cardiac arrest without preparing for ECPR is questionable.
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ter Avest E, Carenzo L, Lendrum RA, Christian MD, Lyon RM, Coniglio C, Rehn M, Lockey DJ, Perkins ZB. Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries. Crit Care 2022; 26:184. [PMID: 35725641 PMCID: PMC9210796 DOI: 10.1186/s13054-022-04052-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood products, resuscitative thoracotomy (RT) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have become available in a small number of pre-hospital critical care teams. Although these advanced techniques are included in the current traumatic cardiac arrest algorithm of the European Resuscitation Council (ERC), published in 2021, clear guidance on the practical application of these techniques in the pre-hospital setting is scarce. This paper provides a scoping review on how these advanced techniques can be incorporated into practice for the resuscitation of patients exsanguinating from NCH after penetrating injuries, based on available literature and the collective experience of several helicopter emergency medical services (HEMS) across Europe who have introduced these advanced resuscitation interventions into routine practice.
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179
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Bhatnagar A, Mackman S. Successful Nonextracorporeal Life Support Resuscitation and Rewarming of a Patient with Hypothermia in Cardiac Arrest. Wilderness Environ Med 2022; 33:476-478. [PMID: 36180333 DOI: 10.1016/j.wem.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
We report full recovery of a patient with hypothermia in cardiac arrest following continuous and prolonged cardiopulmonary resuscitation (CPR) and conventional, nonextracorporeal life support (non-ECLS) methods. A 57-y-old man presented with unwitnessed cardiac arrest and a core temperature of 23°C (73°F). The presenting cardiac rhythm was ventricular fibrillation. The team administered epinephrine and performed defibrillation and CPR. Because ECLS was unavailable at the facility, the medical team externally and internally rewarmed the patient using heated blankets, forced warmed air, thoracic lavage, and warmed IV fluids. The patient achieved return of spontaneous circulation after 4 h 56 min of continuous CPR and rewarming. The medical team admitted the patient to the intensive care unit. He achieved full neurologic recovery the following day. When ECLS is not available and transfer is not appropriate because of patient instability or hospital location, conventional rewarming methods and continuous, prolonged CPR can lead to successful outcomes in patients with hypothermia in cardiac arrest. This case demonstrates that CPR in patients with hypothermia-associated cardiac arrest can lead to full recovery.
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Affiliation(s)
| | - Sean Mackman
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
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180
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Putowski M, Jaskuła J, Woroń J. The amount of calcium in calcium chloride - Is there a need to clarify emergency treatment of hyperkalaemia algorithm? Resuscitation 2022; 181:158-159. [PMID: 36403822 DOI: 10.1016/j.resuscitation.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines emphasize a rapid administration of calcium chloride (10 ml 10 % CaCl2) to protect the myocardium in the hyperkalaemia algorithm. However, calcium chloride preparations available in European markets vary from country to country. In our opinion, the drug dose recommended in the guidelines should not raise questions about the volume and amount of calcium in the intravenous supply and should be unambiguous to minimize the risk of error. Calcium dose should be given in terms of mmol/L or mEq or mg of calcium ions.
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Affiliation(s)
- Mateusz Putowski
- Collegium Medicum Jan Kochanowski University, Kielce, Poland; Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland; Anaesthesiology and Intensive Care Clinical Department, The University Hospital in Krakow, Krakow, Poland.
| | - Jerzy Jaskuła
- Center for Innovative Medical Education, Jagiellonian University Medical College, Krakow, Poland; Anaesthesiology and Intensive Care Clinical Department, The University Hospital in Krakow, Krakow, Poland
| | - Jarosław Woroń
- Anaesthesiology and Intensive Care Clinical Department, The University Hospital in Krakow, Krakow, Poland; Department of Clinical Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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181
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Štěpán J, Šulda M, Tesařík R, Zmeko D, Kuta B, Schaffelhoferová D, Foral D. Hypothermic Cardiac Arrest Managed Successfully by Changing ECMO Configurations. J Cardiothorac Vasc Anesth 2022; 36:4413-4419. [PMID: 36127217 DOI: 10.1053/j.jvca.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Josef Štěpán
- Department of Anesthesiology, Emergency and Intensive Care, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika.
| | - Mirek Šulda
- Department of Cardiac Surgery, Heart Centre, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika
| | - Richard Tesařík
- Department of Anesthesiology, Emergency and Intensive Care, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika
| | - Dušan Zmeko
- Department of Anesthesiology, Emergency and Intensive Care, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika
| | - Bohuslav Kuta
- Department of Cardiac Surgery, Heart Centre, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika
| | - Dita Schaffelhoferová
- Department of Cardiology, Heart Centre, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika
| | - David Foral
- Department of Cardiology, Heart Centre, Nemocnice České Budějovice, a.s., České Budějovice, Česká republika
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182
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Parsons HM, Wood A, Milne A. Resuscitative endovascular balloon occlusion of the aorta. BJA Educ 2022; 22:412-415. [PMID: 36304909 PMCID: PMC9596283 DOI: 10.1016/j.bjae.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Andrew Wood
- Barts Health NHS Trust, Royal London Hospital, London, UK
- London's Air Ambulance, Royal London Hospital, London, UK
| | - Andrew Milne
- Barts Health NHS Trust, Royal London Hospital, London, UK
- Greater Sydney Area Helicopter Emergency Service, New South Wales Ambulance Service, Rozelle, NSW, Australia
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183
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Chiba T, Otaka S, Igeta R, Burns MM, Ikeda S, Shiga T. Epidemiology and clinical outcomes of poisoning-induced cardiac arrest in Japan: Retrospective analysis of a nationwide registry. Resuscitation 2022; 180:52-58. [PMID: 36185034 DOI: 10.1016/j.resuscitation.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poisoning is an important cause of out-of-hospital cardiac arrest which can be challenging to manage. Neurological outcomes after poisoning-induced out-of-hospital cardiac arrest (POHCA) are yet to be fully elucidated. This retrospective cohort study sought to describe the characteristics of POHCA, and identify factors associated with favourable neurologic outcomes. METHODS Cardiac arrests recorded in the "All Japan Utstein Registry" from 1 January 2012 to 31 December 2017 were included. A descriptive analysis of the characteristics of POHCA and non-POHCA patients was performed. Neurological outcomes were compared between the POHCA and non-POHCA groups using logistic regression analysis. Subgroup analysis was performed for patients who underwent prolonged resuscitation. RESULTS Compared to non-POHCA patients (n = 665,262), POHCA patients (n = 1,868) were younger (median age, 80 vs 51 years) and had a lower likelihood of having a witness, bystander cardiopulmonary resuscitation, and an initial shockable rhythm. Multivariable logistic regression analysis showed that POHCA was associated with favourable neurologic outcomes (odds ratio 1.54, 95 % confidence interval 1.19-2.01, p = 0.001). Among patients who received > 30 min of resuscitation, neurologic outcomes were similar in those with POHCA and non-POHCA (favourable neurologic outcome, 1.03 % vs 0.98 %, p = 0.87). CONCLUSIONS POHCA is associated with favourable neurological outcomes and requires aggressive resuscitation. However, in patients who required prolonged resuscitation, the outcomes of POHCA were not different from those of non-POHCA. The decision to perform prolonged resuscitation should be guided on a case-by-case basis based on a range of factors.
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Affiliation(s)
- Takuyo Chiba
- Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan; Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan.
| | - Shunichi Otaka
- Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan; Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
| | - Ryuhei Igeta
- Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan; Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
| | - Michele M Burns
- Harvard Medical Toxicology Program, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Shunya Ikeda
- Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
| | - Takashi Shiga
- Department of Emergency Medicine, International University of Health and Welfare, Narita, Chiba, Japan; Graduate School of Medicine, International University of Health and Welfare, Minatoku, Tokyo, Japan
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184
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Metelmann IB, Metelmann B, Metelmann C, Steimle N, Rübsam ML, Krämer B, Krämer S. [Safety aspects of prehospital thoracic emergency procedures: Results of a survey among German emergency physicians]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 174:43-51. [PMID: 36064703 DOI: 10.1016/j.zefq.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/21/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The safe indication and performance of thoracic emergency procedures are crucial and potentially lifesaving in prehospital emergency care. This study aims to investigate issues of patient safety and quality assurance of prehospital invasive thoracic interventions. The survey does not represent the actual medical care situation but explores reasons for security concerns among emergency physicians. METHODS Using a pre-validated questionnaire, prehospital emergency physicians of three prehospital rescue associations (Zweckverband) in Southwest Saxony, Greifswald, and Vechta, Germany, were queried via the online survey service limesurvey. The survey was conducted between January and March 2022. RESULTS 104 emergency physicians participated (response rate 42.4%) 71 of which fully completed the survey (68%). 79% of the participants stated that they felt safe in performing pleural punction. Common reasons for postponing prehospital thoracic interventions included fear of complications or individual patient characteristics. 90% said that they were familiar with the on-board equipment options, and 60% reported that resources were sufficient to perform double-sided procedures. While in all three regions there is sufficient on-board equipment to perform procedures on two sides, one out of two participants said that lack of equipment deters them from performing prehospital invasive thoracic procedures. Emergency physicians who graduated from trauma courses and/or participate in air rescue are more likely to perform invasive thoracic procedures. More than half of the participants wanted more training in chest tube placement or pleural punction. CONCLUSION Safety in prehospital invasive thoracic procedures needs improvement in structural, procedural, as well as human factors aspects. Safe handling of these rare but vital techniques requires more training. A lack of knowledge of equipment is a significant safety gap. Prehospital ultrasound constitutes a structural element of prehospital diagnostics.
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Affiliation(s)
- Isabella B Metelmann
- Klinik und Poliklinik für Viszeral, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
| | - Bibiana Metelmann
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland
| | - Camilla Metelmann
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland
| | - Nina Steimle
- Klinik und Poliklinik für Viszeral, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Marie-Luise Rübsam
- Klinik für Anästhesie, Intensiv-, Notfall- und Schmerzmedizin, Universitätsmedizin Greifswald KöR, Greifswald, Deutschland; Malteser Lohne e.V., Landkreis Vechta, Lohne, Deutschland
| | - Bernd Krämer
- Rettungszweckverband Südwestsachsen, Plauen, Deutschland
| | - Sebastian Krämer
- Klinik und Poliklinik für Viszeral, Transplantations-, Thorax- und Gefäßchirurgie, Bereich Thoraxchirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
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185
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Ellerton JA, Pasquier M, Paal P, Strapazzon G, Darocha T, Brugger H. A Response to "EDCB ET AA: A Mnemonic for Resuscitating Hypothermic Patients Under Extreme Conditions.". Anesth Analg 2022; 135:e40-e41. [PMID: 36269996 DOI: 10.1213/ane.0000000000006202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, St John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
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186
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Mistry R, Moore J. Management of blunt thoracic trauma. BJA Educ 2022; 22:432-439. [PMID: 36304913 PMCID: PMC9596286 DOI: 10.1016/j.bjae.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- R.N. Mistry
- Gold Coast University Hospital, Southport, QLD, Australia
| | - J.E. Moore
- Wellington Regional Hospital, Wellington, New Zealand
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187
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Rob D, Smalcova J, Smid O, Kral A, Kovarnik T, Zemanek D, Kavalkova P, Huptych M, Komarek A, Franek O, Havranek S, Linhart A, Belohlavek J. Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial. Crit Care 2022; 26:330. [PMID: 36303227 PMCID: PMC9608889 DOI: 10.1186/s13054-022-04199-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. METHODS Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. RESULTS Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001). CONCLUSIONS In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.
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Affiliation(s)
- Daniel Rob
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Jana Smalcova
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ondrej Smid
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ales Kral
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Tomas Kovarnik
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - David Zemanek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Petra Kavalkova
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Michal Huptych
- grid.6652.70000000121738213Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, Prague, Czech Republic
| | - Arnost Komarek
- grid.4491.80000 0004 1937 116XDepartment of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Ondrej Franek
- Emergency Medical Service Prague, Prague, Czech Republic
| | - Stepan Havranek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ales Linhart
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Jan Belohlavek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
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188
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Hleșcu AA, Grigoraș A, Covatariu G, Moscalu M, Amalinei C. The Value of Myocardium and Kidney Histopathological and Immunohistochemical Findings in Accidental Hypothermia-Related Fatalities. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1507. [PMID: 36363464 PMCID: PMC9694447 DOI: 10.3390/medicina58111507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 08/30/2023]
Abstract
Background and Objectives: The post-mortem diagnosis of hypothermia is challenging in forensics. The aim of our study was to detect the kidney and heart histopathological changes that occurred in a group of hypothermia-related fatalities. Materials and Methods: The cohort included 107 cases identified in the database of our department between 2007 and 2021, which have been associated with extreme cold stress. Demographic and clinicopathological data were collected from the medico-legal reports. Archived tissue samples were evaluated to identify the histopathological features, in routine haematoxylin-eosin (H&E), Periodic acid-Schiff (PAS), and Masson's trichrome stainings, while cardiac sirtuin1 (SIRT1) and renal ubiquitin (Ub) immunostaining have been performed. Results: The majority of cases exposed to low temperatures were males (76%) from rural regions (68.2%) during the cold season. Paradoxical undressing was documented in 9.3% of cases. The common comorbidities included alcoholism (50.5%), neuropsychiatric diseases (10.3%), diabetes mellitus (3.7%), and lung tuberculosis (4.7%). The microscopic heart exam revealed areas of myocardial degeneration (100%), contraction bands (95.3%), fatty change (13.1%) and focal wavy contractile myocardial cells. Basal vacuolisation of renal tubular epithelial cells (Armanni-Ebstein lesions) (21.5%), focal tubular necrosis (7.5%), tubular renal cysts (7.5%), interstitial haemorrhages (5.6%), diabetic kidney disease (3.7%), background benign nephroangiosclerosis (42.1%), variable thickening of tubules and corpuscles basement membranes, capsular space amorphous material, and intratubular casts were identified in kidney tissue samples. Myocardial cells displayed SIRT1 weak expression, with a loss of immunopositivity correlated with areas with contraction bands, while a variable Ub expression was observed in renal corpuscles capsules, proximal, distal, and collecting renal tubules, Henle's loops, urothelium, and intratubular casts. Conclusions: In the context of the current concept that death associated with hypothermia is still a diagnosis of exclusion, our findings suggest that the microscopic exam provides relevant data that support the diagnosis of hypothermia-related fatalities in appropriate circumstances of death. A deeper insight into the histopathologic findings in hypothermic patients may lead to new therapeutic approaches in these cases.
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Affiliation(s)
- Andreea Alexandra Hleșcu
- Legal Medicine Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Grigoraș
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Histopathology, Institute of Legal Medicine, 700455 Iasi, Romania
| | - Gabriela Covatariu
- Faculty of Civil Engineering and Building Services, “Gheorghe Asachi” Technical University, 700050 Iasi, Romania
| | - Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cornelia Amalinei
- Department of Morphofunctional Sciences I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Histopathology, Institute of Legal Medicine, 700455 Iasi, Romania
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189
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Schumann C, Wiege S. Arzthaftung und Strafrecht in der Akutmedizin. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01088-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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190
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Ohlén D, Hedberg M, Martinsson P, von Oelreich E, Djärv T, Jonsson Fagerlund M. Characteristics and outcome of traumatic cardiac arrest at a level 1 trauma centre over 10 years in Sweden. Scand J Trauma Resusc Emerg Med 2022; 30:54. [PMID: 36253786 PMCID: PMC9575295 DOI: 10.1186/s13049-022-01039-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background Historically, resuscitation in traumatic cardiac arrest (TCA) has been deemed futile. However, recent literature reports improved but varying survival. Current European guidelines emphasise the addressing of reversible aetiologies in TCA and propose that a resuscitative thoracotomy may be performed within 15 min from last sign of life. To improve clinician understanding of which patients benefit from resuscitative efforts we aimed to describe the characteristics and 30-day survival for traumatic cardiac arrest at a Swedish trauma centre with a particular focus on resuscitative thoracotomy. Methods Retrospective cohort study of adult patients (≥ 15 years) with TCA managed at Karolinska University Hospital Solna between 2011 and 2020. Trauma demographics, intra-arrest factors, lab values and procedures were compared between survivors and non-survivors. Results Among the 284 included patients the median age was 38 years, 82.2% were male and 60.5% were previously healthy. Blunt trauma was the dominant injury in 64.8% and median Injury Severity Score (ISS) was 38. For patients with a documented arrest rhythm, asystole was recorded in 39.2%, pulseless electric activity in 24.8% and a shockable rhythm in 6.8%. Thirty patients (10.6%) survived to 30 days with a Glasgow Outcome Scale score of 3 (n = 23) or 4 (n = 7). The most common causes of death were haemorrhagic shock (50.0%) and traumatic brain injury (25.5%). Survivors had a lower ISS (P < 0.001), more often had reactive pupils (P < 0.001) and a shockable rhythm (P = 0.04). In the subset of prehospital TCA, survivors less frequently received adrenaline (epinephrine) (P < 0.001) and in lower amounts (P = 0.02). Of patients that underwent resuscitative thoracotomy (n = 101), survivors (n = 12) had a shorter median time from last sign of life to thoracotomy (P = 0.03), however in four of these survivors the time exceeded 15 min. Conclusion Survival after TCA is possible. Determining futility in TCA is difficult and this study demonstrates survivors outside of recent guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-01039-9.
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Affiliation(s)
- Daniel Ohlén
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Magnus Hedberg
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Paula Martinsson
- Department of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik von Oelreich
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Therese Djärv
- Department of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
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191
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Seewald S, Wnent J, Gässler H, Fischer M. Plötzlicher Herz-Kreislauf-Stillstand und Reanimation im Sport. Notf Rett Med 2022. [DOI: 10.1007/s10049-022-01080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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192
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Djarv T. What is harmless but can kill you? Resuscitation 2022; 179:274-276. [PMID: 36099981 DOI: 10.1016/j.resuscitation.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Therese Djarv
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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193
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Bagou G, Sentilhes L, Mercier FJ, Berveiller P, Blanc J, Cesareo E, Dewandre PY, Douai B, Gloaguen A, Gonzalez M, Le Conte P, Le Gouez A, Madar H, Maisonneuve E, Morau E, Rackelboom T, Rossignol M, Sibiude J, Vaux J, Vivanti A, Goddet S, Rozenberg P, Garnier M, Chauvin A. Guidelines for the management of urgent obstetric situations in emergency medicine, 2022. Anaesth Crit Care Pain Med 2022; 41:101127. [PMID: 35940033 DOI: 10.1016/j.accpm.2022.101127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To provide recommendations on the management of urgent obstetrical emergencies outside the maternity ward. DESIGN A group of 24 experts from the French Society of Emergency Medicine (SFMU), the French Society of Anaesthesia and Intensive Care Medicine (SFAR) and the French College of Gynaecologists and Obstetricians (CNGOF) was convened. Potential conflicts of interest were formally declared at the outset of the guideline development process, which was conducted independently of industry funding. The authors followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the level of evidence in the literature. The potential drawbacks of strong recommendations in the presence of low-level evidence were highlighted. Some recommendations with an insufficient level of evidence were not graded. METHODS Eight areas were defined: imminent delivery, postpartum haemorrhage (prevention and management), threat of premature delivery, hypertensive disorders in pregnancy, trauma, imaging, cardiopulmonary arrest, and emergency obstetric training. For each field, the expert panel formulated questions according to the PICO model (population, intervention, comparison, outcomes) and an extensive literature search was conducted. Analysis of the literature and formulation of recommendations were conducted according to the GRADE method. RESULTS Fifteen recommendations on the management of obstetrical emergencies were issued by the SFMU/SFAR/CNGOF panel of experts, and 4 recommendations from formalised expert recommendations (RFE) established by the same societies were taken up to answer 4 PICO questions dealing with the pre-hospital context. After two rounds of voting and several amendments, strong agreement was reached for all the recommendations. For two questions (cardiopulmonary arrest and inter-hospital transfer), no recommendation could be made. CONCLUSIONS There was significant agreement among the experts on strong recommendations to improve practice in the management of urgent obstetric complications in emergency medicine.
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Affiliation(s)
- Gilles Bagou
- SAMU-SMUR of Lyon, University Hospital Edouard Herriot, Lyon, France.
| | - Loïc Sentilhes
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | - Frédéric J Mercier
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Paul Berveiller
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Julie Blanc
- Gynaecology and Obstetrics Department, University Hospital Hôpital Nord, Marseille, France
| | - Eric Cesareo
- SAMU-SMUR 69, University Hospital Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Dewandre
- Department of Anaesthesiology and Critical Care Medicine, University hospital of Liège, Liège, Belgium
| | | | - Aurélie Gloaguen
- Emergency Department, Hospital William Morey, Chalon-sur-Saone, France
| | - Max Gonzalez
- Department of Anaesthesiology and Critical Care Medicine in Gynaecology and Obstetrics, University Hospital Jeanne de Flandre, Lille, France
| | | | - Agnès Le Gouez
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Antoine Béclère, Clamart, France
| | - Hugo Madar
- Gynaecology and Obstetrics Department, University Hospital Pellegrin, Bordeaux, France
| | | | - Estelle Morau
- Department of Anaesthesiology, Critical Care, Pain and Emergency, University hospital Carémeau, Nîmes, France
| | - Thibaut Rackelboom
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Pellegrin, Bordeaux, France
| | - Mathias Rossignol
- University Paris Cité - APHP Nord, Department of Anaesthesiology and Critical Care Medicine, University Hospital Lariboisière, Paris, France
| | - Jeanne Sibiude
- Gynaecology and Obstetrics Department, University Hospital Louis Mourier, Colombes, France
| | - Julien Vaux
- SMUR 94, University Hospital Henri Mondor, Créteil, France
| | - Alexandre Vivanti
- Gynaecology and Obstetrics Department, Antoine Béclère University Hospital, Clamart, France
| | - Sybille Goddet
- SAMU-SMUR 21 and Emergency Department, University Hospital of Dijon, Dijon, France
| | - Patrick Rozenberg
- Gynaecology and Obstetrics Department, CHI Poissy Saint-Germain, Poissy, France
| | - Marc Garnier
- Sorbonne University, GRC29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France
| | - Anthony Chauvin
- SAMU-SMUR 75 and Emergency Department, Lariboisière University Hospital, Paris, France; Université de Paris, INSERM U942 MASCOT, Paris, France
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194
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Lin C, Chen CC, Chau T, Lin CS, Tsai SH, Lee DJ, Lee CC, Shang HS, Lin SH. Artificial intelligence-enabled electrocardiography identifies severe dyscalcemias and has prognostic value. Clin Chim Acta 2022; 536:126-134. [PMID: 36167147 DOI: 10.1016/j.cca.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
CONTEXT Abnormal serum calcium concentrations affect the heart and may alter the electrocardiogram (ECG), but the detection of hypocalcemia and hypercalcemia (collectively dyscalcemia) relies on blood laboratory tests requiring turnaround time. OBJECTIVE The study aimed to develop a bloodless artificial intelligence (AI)-enabled (ECG) method to rapidly detect dyscalcemia and analyze its possible utility for outcome prediction. METHODS This study collected 86,731 development, 15,611 tuning, 11,105 internal validation, and 8401 external validation ECGs from electronic medical records with at least 1 ECG associated with an albumin-adjusted calcium (aCa) value within 4 h. The main outcomes were to assess the accuracy of AI-ECG to predict aCa and follow up these patients for all-cause mortality, new-onset acute myocardial infraction (AMI), and new-onset heart failure (HF) to validate the ability of AI-ECG-aCa for previvor identification. RESULTS ECG-aCa had mean absolute errors (MAE) of 0.78/0.98 mg/dL and achieved an area under receiver operating characteristic curves (AUCs) 0.9219/0.8447 and 0.8948/0.7723 to detect severe hypercalcemia and hypocalcemia in the internal/external validation sets, respectively. Although < 20 % variance of ECG-aCa could be explained by traditional ECG features, the ECG-aCa was found to be associated with more complications. Patients with ECG-hypercalcemia but initially normal aCa were found to have a higher risk of subsequent all-cause mortality [hazard ratio (HR): 2.05, 95 % conference interval (CI): 1.55-2.70], new-onset AMI (HR: 2.88, 95 % CI: 1.72-4.83), and new-onset HF (HR: 2.02, 95 % CI: 1.38-2.97) in the internal validation set, which were also seen in external validation. CONCLUSION The AI-ECG-aCa may help detecting severe dyscalcemia for early diagnosis and ECG-hypercalcemia also has prognostic value for clinical outcomes (all-cause mortality and new-onset AMI and HF).
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Affiliation(s)
- Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chien-Chou Chen
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tom Chau
- Department of Medicine, Providence St. Vincent Medical Center, Portland, OR, USA
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shi-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ding-Jie Lee
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Cheng Lee
- Department of Medical Informatics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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195
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Seewald S, Wnent J, Gräsner JT, Tjelmeland I, Fischer M, Bohn A, Bouillon B, Maurer H, Lefering R. Survival after traumatic cardiac arrest is possible—a comparison of German patient-registries. BMC Emerg Med 2022; 22:158. [PMID: 36085024 PMCID: PMC9463728 DOI: 10.1186/s12873-022-00714-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) due to trauma is rare, and survival in this group is infrequent. Over the last decades, several new procedures have been implemented to increase survival, and a “Special circumstances chapter” was included in the European Resuscitation Council (ERC) guidelines in 2015. This article analysed outcomes after traumatic cardiac arrest in Germany using data from the German Resuscitation Registry (GRR) and the TraumaRegister DGU® (TR-DGU) of the German Trauma Society.
Methods
In this study, data from patients with OHCA between 01.01.2014 and 31.12.2019 secondary to major trauma and where cardiopulmonary resuscitation (CPR) was started were eligible for inclusion. Endpoints were return of spontaneous circulation (ROSC), hospital admission with ROSC and survival to hospital discharge.
Results
1.049 patients were eligible for inclusion. ROSC was achieved in 28.7% of the patients, 240 patients (22.9%) were admitted to hospital with ROSC and 147 (14.0%) with ongoing CPR. 643 (67.8%) patients were declared dead on scene. Of all patients resuscitated after traumatic OHCA, 27.3% (259) died in hospital. The overall mortality was 95.0% and 5.0% survived to hospital discharge (47). In a multivariate logistic regression analysis; age, sex, injury severity score (ISS), head injury, found in cardiac arrest, shock on admission, blood transfusion, CPR in emergency room (ER), emergency surgery and initial electrocardiogram (ECG), were independent predictors of mortality.
Conclusion
Traumatic cardiac arrest was an infrequent event with low overall survival. The mortality has remained unchanged over the last decades in Germany. Additional efforts are necessary to identify reversible cardiac arrest causes and provide targeted trauma resuscitation on scene.
Trial registration
DRKS, DRKS-ID DRKS00027944. Retrospectively registered 03/02/2022.
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196
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Okada Y, Matsuyama T, Hayashida K, Takauji S, Kanda J, Yokobori S. Difference between 5A score and the HOPE score. J Intensive Care 2022; 10:42. [PMID: 36085076 PMCID: PMC9463730 DOI: 10.1186/s40560-022-00636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Recently, a letter to the editor was published to comment on the 5A score which is the prediction model for accidental hypothermia patients comparing the HOPE score. In this letter, we responded to the comments to clarify the difference between the 5A score and the HOPE score.
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Affiliation(s)
- Yohei Okada
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan. .,Department of Preventive Services, Graduate School of Medicine, Kyoto University, ShogoinKawaramachi54, Kyoto, Sakyo, 606-8507, Japan. .,Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Hayashida
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Emergency Medicine, North Shore University Hospital, Northwell Health System, Manhasset, NY, USA
| | - Shuhei Takauji
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency Medicine, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Jun Kanda
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency Medicine, Teikyo University Hospital, Tokyo, Japan
| | - Shoji Yokobori
- Japan Association of Acute Medicine Heatstroke and Hypothermia Surveillance Committee, Tokyo, Japan.,Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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197
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Lanyi M, Elmer J, Guyette FX, Martin-Gill C, Venkat A, Traynor O, Walker H, Seaman K, Kochanek PM, Fink EL. Survival Rates After Pediatric Traumatic Out-of-Hospital Cardiac Arrest Suggest an Underappreciated Therapeutic Opportunity. Pediatr Emerg Care 2022; 38:417-422. [PMID: 35947060 PMCID: PMC9427720 DOI: 10.1097/pec.0000000000002806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with traumatic arrests represent almost one third of annual pediatric out-of-hospital cardiac arrests (OHCAs). However, traumatic arrests are often excluded from study populations because survival posttraumatic arrest is thought to be negligible. We hypothesized that children treated and transported by emergency medical services (EMS) personnel after traumatic OHCA would have lower survival compared with children treated after medical OHCA. METHODS We performed a secondary, observational study of children younger than 18 years treated and transported by 78 EMS agencies in southwestern Pennsylvania after OHCA from 2010 to 2014. Etiology was determined as trauma or medical by EMS services. We analyzed patient, cardiac arrest, and resuscitation characteristics and ascertained vital status using the National Death Index. We used multivariable logistic regression to test the association of etiology with mortality after covariate adjustment. RESULTS Forty eight of 209 children (23%) had traumatic OHCA. Children with trauma were older than those with medical OHCA (13.2 [3.8-15.9] vs 0.5 [0.2-2.4] years, P < 0.001). Prehospital return of spontaneous circulation frequency for trauma versus medical etiology was similar (90% vs 87%, P = 0.84). Patients with trauma had higher mortality (69% vs 45% P = 0.004). CONCLUSIONS More than 8 of 10 children with EMS treated and transported OHCA achieved return of spontaneous circulation. Despite lower survival rates than medical OHCA patients, almost one third of children with a traumatic etiology survived throughout the study period. Future research programs warrant inclusion of children with traumatic OHCA to improve outcomes.
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Affiliation(s)
- Maria Lanyi
- From the University of Pittsburgh Medical School
| | | | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine
| | | | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network
| | - Owen Traynor
- Department of Emergency Medicine, St Clair Hospital, Pittsburgh
| | - Heather Walker
- Department of Emergency Medicine, Excela Health, Greensburg
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198
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Hitosugi T, Awata N, Miki Y, Tsukamoto M, Yokoyama T. Comparison of different methods of more effective chest compressions during cardiopulmonary resuscitation (CPR) in the dental chair. Resusc Plus 2022; 11:100286. [PMID: 35992958 PMCID: PMC9382314 DOI: 10.1016/j.resplu.2022.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction When performing cardiopulmonary resuscitation (CPR) on a patient who has suffered a cardiopulmonary arrest during dental treatment, few dental chairs have sufficient stability to perform effective chest compressions. We previously proposed a method of stabilizing the backrest of a dental chair using a support stool. As a result, we confirmed that the vertical displacement of the backrest could be significantly reduced. In the present study, we verified the effectiveness of the stool stabilization method using several dental chairs (flat and curved) with significantly different backrest shapes. Methods Vertical displacement of the backrests of dental chairs was recorded. Data were obtained at three different stool positions (without a stool, under the chest at the level that participants were performing manual chest compressions, and under the shoulders). Reduction displacement ratios were calculated to evaluate the effectiveness of the stool positions. Results The method significantly reduced the vertical displacement of the backrest for all types. When the curvature of the backrest was large, the reduction in vertical displacement was 40% when the stool was placed under the chest at the level of manual chest compressions and 65% when placed underneath the shoulder. In the case of a flat dental chair, this reduction was 90% when using a stool in either position, compared to no stool. Conclusion When we need to perform CPR on a patient in the dental chair, placing a stool under the shoulders allows effective manual chest compression by firmly supporting the backrest of a dental chair of any shape.
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Affiliation(s)
- Takashi Hitosugi
- Section of Dental Anesthesiology, Division of Maxillofacial Diagnostic & Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
- Corresponding author.
| | - Norimasa Awata
- Smile Dental Clinic, 1-1-5 Kamimoto-cho-nishi, Chuo-ku, Osaka City, Osaka 542-0062, Japan
| | - Yoichiro Miki
- School of Interdisciplinary Science and Innovation, Faculty of Arts and Science, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka-shi, Fukuoka 812-8582, Japan
| | - Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
| | - Takeshi Yokoyama
- Section of Dental Anesthesiology, Division of Maxillofacial Diagnostic & Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
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199
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Pre-hospital blood products and calcium replacement protocols in UK critical care services: A survey of current practice. Resusc Plus 2022; 11:100282. [PMID: 35968196 PMCID: PMC9364118 DOI: 10.1016/j.resplu.2022.100282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction In the United Kingdom, prehospital blood products are increasingly carried for the early resuscitation of hypovolaemia in patients who are shocked or in cardiac arrest. There is an association between hypocalcaemia and mortality in trauma patients, but no current national guidelines on the timing or dose of calcium replacement exist. The objective of this study was to establish the availability of prehospital blood products, and the current calcium replacement protocols used by UK prehospital services. Methods A cross sectional survey of all UK air ambulances and additional prehospital critical care organisations was conducted in April-May 2022 via an on-line questionnaire. The survey asked 11 questions about availability of prehospital blood products, calcium replacement for patients requiring prehospital blood products, and the use of point of care testing. Results There was a 100% response rate with 20/22 UK air ambulances carrying blood products and five additional prehospital services identified. There were 15 different combinations of prehospital blood products. 23/25 services had a standard operating procedure for the replacement of calcium. This was recommended before any blood product administration in 5 services (22%), during or after the 1st unit in 5 services (22%), during or after the 2nd unit in 6 services (26%) and during or after the 4th unit in 7 services (30%). Only six services carried point of care testing and no services routinely used this to measure calcium levels in patients requiring prehospital blood products. Conclusion In 2022, 91% of UK air ambulances carry prehospital blood products and there is significant variation between services in the combination of blood products provided. There is no consensus on the timing or dose of calcium replacement. Further prospective research should examine the association between traumatic bleeding and ionized calcium levels before and during blood product transfusion in order to produce more robust guidelines for routine calcium replacement.
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200
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Schnaubelt S, Eibensteiner F, Merrelaar M, Tihanyi D, Strassl R, Clodi C, Domanovits H, Losert H, Holzer M. Adult Respiratory Syncytial Virus Infection and Hypoxic Cardiac Arrest—Coexistent or Causal? A Hypothesis-Generating Case Report. Medicina (B Aires) 2022; 58:medicina58081121. [PMID: 36013588 PMCID: PMC9416440 DOI: 10.3390/medicina58081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a well-known pathogen in paediatric patients. However, it also causes substantial morbidity and mortality in adults, posing a major healthcare problem. We present a patient with chronic pulmonary conditions and an acute RSV infection, thus leading to cardiac arrest (CA). We speculate that RSV as the causative agent for CA should be considered in post-resuscitation care. From a wider public health perspective, immuno-naivety for RSV caused by the coronavirus disease 2019 pandemic may induce a severe rise in cases, morbidity, and mortality in the future.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Felix Eibensteiner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Marieke Merrelaar
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniel Tihanyi
- Department of Pulmonology, Clinic Penzing, Vienna Healthcare Group, 1140 Vienna, Austria
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Christian Clodi
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Heidrun Losert
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
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