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Nakaya H, Okamoto R, Ogihara Y, Sato T, Ito M, Dohi K. Giant deep vein thrombus complicating endovascular cooling therapy after cardiac arrest in a boy with hypertrophic cardiomyopathy. J Cardiol Cases 2021; 23:189-191. [PMID: 33841599 DOI: 10.1016/j.jccase.2021.02.001] [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: 10/31/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Mild hypothermia therapy (33-36 °C) is useful in preventing anoxic brain injury occurring after return of spontaneous circulation among survivors of cardiac arrest. Adverse events generally include bleeding, pneumonia, bradycardia, and deep vein thrombosis (DVT). However, one rare complication is huge DVT. We recently encountered a boy with ventricular fibrillation due to hypertrophic cardiomyopathy complicated by huge DVT from bilateral common femoral veins close to the hepatic vein during endovascular cooling therapy via his femoral vein. We successfully managed this case without any complications after infusion of unfractionated heparin to maintain a relatively high activated partial thromboplastin time. <Learning objective: We should be more careful in screening for deep vein thrombosis before and after endovascular cooling therapy.>.
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Affiliation(s)
- Hitoshi Nakaya
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.,Regional Medical Support Center, Mie University Hospital, Tsu, Japan
| | - Yoshito Ogihara
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Toru Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Lee D, Cho Y, Ko Y, Heo NH, Kang HG, Han S. Neuron-specific enolase level as a predictor of neurological outcome in near-hanging patients: A retrospective multicenter study. PLoS One 2021; 16:e0246898. [PMID: 33566872 PMCID: PMC7875384 DOI: 10.1371/journal.pone.0246898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Neuron-specific enolase (NSE) is frequently used to predict neurological outcomes in patients with hypoxic brain injury. Hanging can cause hypoxic brain damage, and survivors can suffer from neurological deficits that may impair daily activities. Here, we investigated the utility of the initial serum NSE level as a predictor of neurological outcomes in near-hanging patients with decreased consciousness. Methods This retrospective multicenter study was conducted in patients who visited the emergency department due to near-hanging injury from October 2013 to February 2019 at three university hospitals in Korea. They were divided into two groups according to the presence of out-of-hospital cardiac arrest. The neurological outcome was determined using the Cerebral Performance Category (CPC) measured at the time of discharge. Multivariate analysis was performed to determine whether initial serum NSE is an independent predictor of neurological outcome. Results Of the 70 patients included in the study, 44 showed a poor neurological outcome (CPC score = 3–5). Among the 52 patients with cardiac arrest, only 10 (19.2%) were discharged with good neurological outcome (CPC score = 1–2). In the whole cohort, a high serum NSE level was a significant predictor of poor neurological outcome (odds ratio [OR], 1.343; 95% confidence interval [CI], 1.003–1.800, p = 0.048). Among the patients with cardiac arrest, a high serum NSE level was a significant predictor of poor neurological outcome (OR, 1.138; 95% CI, 1.009–1.284, p = 0.036). Conclusions In near-hanging patients, a high initial serum NSE level is an independent predictor of poor neurological outcome.
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Affiliation(s)
- Dongwook Lee
- Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Yongil Cho
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Yujin Ko
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Nam Hun Heo
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyung Goo Kang
- Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Do SN, Luong CQ, Pham DT, Nguyen CV, Ton TT, Pham TT, Hoang QT, Hoang HT, Nguyen DT, Khuong DQ, Nguyen QH, Nguyen TA, Pham HT, Nguyen MH, McNally BF, Ong ME, Nguyen AD. Survival after out-of-hospital cardiac arrest, Viet Nam: multicentre prospective cohort study. Bull World Health Organ 2020; 99:50-61. [PMID: 33658734 DOI: 10.2471/blt.20.269837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/14/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate factors associated with survival after out-of-hospital cardiac arrest in Viet Nam. Methods We did a multicentre prospective observational study of people (> 18 years) presenting with out-of-hospital cardiac arrest (not caused by trauma) to three tertiary hospitals in Viet Nam from February 2014 to December 2018. We collected data on characteristics, management and outcomes of patients with out-of-hospital cardiac arrest and compared these data by type of transportation to hospital and survival to hospital admission. We assessed factors associated with survival to admission to and discharge from hospital using logistic regression analysis. Findings Of 590 eligible people with out-of-hospital cardiac arrest, 440 (74.6%) were male and the mean age was 56.1 years (standard deviation: 17.2). Only 24.2% (143/590) of these people survived to hospital admission and 14.1% (83/590) survived to hospital discharge. Most cardiac arrests (67.8%; 400/590) occurred at home, 79.4% (444/559) were witnessed by bystanders and 22.3% (124/555) were given cardiopulmonary resuscitation by a bystander. Only 8.6% (51/590) of the people were taken to hospital by the emergency medical services and 32.2% (49/152) received pre-hospital defibrillation. Pre-hospital defibrillation (odds ratio, OR: 3.90; 95% confidence interval, CI: 1.54-9.90) and return of spontaneous circulation in the emergency department (OR: 2.89; 95% CI: 1.03-8.12) were associated with survival to hospital admission. Hypothermia therapy during post-resuscitation care was associated with survival to discharge (OR: 5.44; 95% CI: 2.33-12.74). Conclusion Improvements are needed in the emergency medical services in Viet Nam such as increasing bystander cardiopulmonary resuscitation and public access defibrillation, and improving ambulance and post-resuscitation care.
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Affiliation(s)
- Son N Do
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Chinh Q Luong
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Dung T Pham
- Department of Nutrition and Food Safety, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Chi V Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Tra T Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Thao Tn Pham
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Quoc Ta Hoang
- Emergency Department, Hue Central General Hospital, Hue, Viet Nam
| | - Hanh T Hoang
- Intensive Care Unit, Hue Central General Hospital, Hue, Viet Nam
| | - Dat T Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Dai Q Khuong
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Quan H Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Tuan A Nguyen
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Hanh Tm Pham
- Department of Epidemiology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - My H Nguyen
- Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Bryan F McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, United States of America
| | - Marcus Eh Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Anh D Nguyen
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
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Long B, Koyfman A, Gottlieb M. Targeted Temperature Management in Post-Cardiac Arrest Patients. Acad Emerg Med 2020; 27:517-519. [PMID: 31828912 DOI: 10.1111/acem.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Brit Long
- From the Department of Emergency Medicine Brooke Army Medical Center Fort Sam Houston TX
| | - Alex Koyfman
- the Department of Emergency Medicine The University of Texas Southwestern Medical Center Dallas TX
| | - Michael Gottlieb
- and the Department of Emergency Medicine Rush University Medical Center Chicago IL
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Hosseini M, Wilson RH, Crouzet C, Amirhekmat A, Wei KS, Akbari Y. Resuscitating the Globally Ischemic Brain: TTM and Beyond. Neurotherapeutics 2020; 17:539-562. [PMID: 32367476 PMCID: PMC7283450 DOI: 10.1007/s13311-020-00856-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cardiac arrest (CA) afflicts ~ 550,000 people each year in the USA. A small fraction of CA sufferers survive with a majority of these survivors emerging in a comatose state. Many CA survivors suffer devastating global brain injury with some remaining indefinitely in a comatose state. The pathogenesis of global brain injury secondary to CA is complex. Mechanisms of CA-induced brain injury include ischemia, hypoxia, cytotoxicity, inflammation, and ultimately, irreversible neuronal damage. Due to this complexity, it is critical for clinicians to have access as early as possible to quantitative metrics for diagnosing injury severity, accurately predicting outcome, and informing patient care. Current recommendations involve using multiple modalities including clinical exam, electrophysiology, brain imaging, and molecular biomarkers. This multi-faceted approach is designed to improve prognostication to avoid "self-fulfilling" prophecy and early withdrawal of life-sustaining treatments. Incorporation of emerging dynamic monitoring tools such as diffuse optical technologies may provide improved diagnosis and early prognostication to better inform treatment. Currently, targeted temperature management (TTM) is the leading treatment, with the number of patients needed to treat being ~ 6 in order to improve outcome for one patient. Future avenues of treatment, which may potentially be combined with TTM, include pharmacotherapy, perfusion/oxygenation targets, and pre/postconditioning. In this review, we provide a bench to bedside approach to delineate the pathophysiology, prognostication methods, current targeted therapies, and future directions of research surrounding hypoxic-ischemic brain injury (HIBI) secondary to CA.
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Affiliation(s)
- Melika Hosseini
- Department of Neurology, School of Medicine, University of California, Irvine, USA
| | - Robert H Wilson
- Department of Neurology, School of Medicine, University of California, Irvine, USA
- Beckman Laser Institute, University of California, Irvine, USA
| | - Christian Crouzet
- Department of Neurology, School of Medicine, University of California, Irvine, USA
- Beckman Laser Institute, University of California, Irvine, USA
| | - Arya Amirhekmat
- Department of Neurology, School of Medicine, University of California, Irvine, USA
| | - Kevin S Wei
- Department of Neurology, School of Medicine, University of California, Irvine, USA
| | - Yama Akbari
- Department of Neurology, School of Medicine, University of California, Irvine, USA.
- Beckman Laser Institute, University of California, Irvine, USA.
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