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Zali M, Rahmani A, Hassankhani H, Namdar-Areshtanab H, Gilani N, Azadi A, Ghafourifard M. Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis. BMC Nurs 2024; 23:150. [PMID: 38433187 PMCID: PMC10910715 DOI: 10.1186/s12912-024-01814-2] [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: 04/05/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. AIM This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. METHODS A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. RESULTS Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. CONCLUSION Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.
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Affiliation(s)
- Mahnaz Zali
- Nursing faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Nursing faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hadi Hassankhani
- Nursing faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Neda Gilani
- Health faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arman Azadi
- Nursing faculty, Ilam University of Medical Sciences, Ilam, Iran
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Kurek K, Swieczkowski D, Pruc M, Tomaszewska M, Cubala WJ, Szarpak L. Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7655. [PMID: 38137724 PMCID: PMC10744223 DOI: 10.3390/jcm12247655] [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: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
The prediction of outcomes following cardiac arrest continues to provide significant difficulties. A preferred strategy involves adopting a multimodal approach, which encompasses the careful evaluation of the biomarker neuron-specific enolase (NSE). This systematic review and meta-analysis aimed to gather and summarize new and existing evidence on the prediction effect of neuron-specific enolase for survival to hospital discharge among adult patients with cardiac arrest. We searched PubMed Central, Scopus, EMBASE databases, and the Cochrane Library without language restrictions from their inceptions until 30 October 2023 and checked the reference lists of the included studies. Pooled results were reported as standardized mean differences (SMDs) and were presented with corresponding 95% confidence intervals (CIs). The primary outcome was survival to hospital discharge (SHD). Eighty-six articles with 10,845 participants were included. NSE showed a notable degree of specificity in its ability to predict mortality as well as neurological status among individuals who experienced cardiac arrest (p < 0.05). This study demonstrates the ability to predict fatality rates and neurological outcomes, both during the time of admission and at various time intervals after cardiac arrest. The use of NSE in a multimodal neuroprognostication algorithm has promise in improving the accuracy of prognoses for persons who have undergone cardiac arrest.
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Affiliation(s)
- Krzysztof Kurek
- Department of Clinical Research and Development, LUXMED Group, 02-676 Warsaw, Poland
| | - Damian Swieczkowski
- Department of Toxicology, Faculty of Pharmacy, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Public Health, International Academy of Ecology and Medicine, 02000 Kyiv, Ukraine
| | - Monika Tomaszewska
- Department of Clinical Research and Development, LUXMED Group, 02-676 Warsaw, Poland
| | | | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 15-027 Bialystok, Poland
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3
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Rajan D, Garcia R, Barcella CA, Svane J, Warming PE, Jabbari R, Gislason GH, Torp-Pedersen C, Folke F, Tfelt-Hansen J. Outcomes after out-of-hospital cardiac arrest in immigrants vs natives in Denmark. Resuscitation 2023; 190:109872. [PMID: 37327849 DOI: 10.1016/j.resuscitation.2023.109872] [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: 03/05/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
AIMS Ethnic disparities subsist in out-of-hospital cardiac arrest (OHCA) outcomes in the US, yet it is unresolved whether similar inequalities exist in European countries. This study compared survival after OHCA and its determinants in immigrants and non-immigrants in Denmark. METHODS Using the nationwide Danish Cardiac Arrest Register, 37,622 OHCAs of presumed cardiac cause between 2001 and 2019 were included, 95% in non-immigrants and 5% in immigrants. Univariate and multiple logistic regression was used to assess disparities in treatments, return of spontaneous circulation (ROSC) at hospital arrival, and 30-day survival. RESULTS Immigrants were younger at OHCA (median 64 [IQR 53-72] vs 68 [59-74] years; p < 0.05), had more prior myocardial infarction (15% vs 12%, p < 0.05), more diabetes (27% vs 19%, p < 0.05), and were more often witnessed (56% vs 53%; p < 0.05). Immigrants received similar bystander cardiopulmonary resuscitation and defibrillation rates to non-immigrants, but more coronary angiographies (15% vs 13%; p < 0.05) and percutaneous coronary interventions (10% vs 8%, p < 0.05), although this was insignificant after age-adjustment. Immigrants had higher ROSC at hospital arrival (28% vs 26%; p < 0.05) and 30-day survival (18% vs 16%; p < 0.05) compared to non-immigrants, but adjusting for age, sex, witness status, first observed rhythm, diabetes, and heart failure rendered the difference non-significant (odds ratios (OR) 1.03, 95% confidence interval (CI) 0.92-1.16 and OR 1.05, 95% CI 0.91-1.20, respectively). CONCLUSIONS OHCA management was similar between immigrants and non-immigrants, resulting in similar ROSC at hospital arrival and 30-day survival after adjustments.
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Affiliation(s)
- Deepthi Rajan
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. https://twitter.com/RajanDeepthi
| | - Rodrigue Garcia
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Cardiology Department, University Hospital of Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France; Centre d'Investigation Clinique 1402, University Hospital of Poitiers, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Carlo A Barcella
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Jesper Svane
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peder E Warming
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; Copenhagen Emergency Medical Services, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
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Mark J, Lopez J, Wahood W, Dodge J, Belaunzaran M, Losiniecki F, Santos-Roman Y, Danckers M. The role of targeted temperature management in 30-day hospital readmissions in cardiac arrest survivors: A national population-based study. IJC HEART & VASCULATURE 2023; 46:101207. [PMID: 37113651 PMCID: PMC10127122 DOI: 10.1016/j.ijcha.2023.101207] [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: 02/27/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Background Targeted temperature management (TTM) implementation following resuscitation from cardiac arrest is controversial. Although prior studies have shown that TTM improves neurological outcomes and mortality, less is known about the rates or causes of readmission in cardiac arrest survivors within 30 days. We aimed to determine whether the implementation of TTM improves all-cause 30-day unplanned readmission rates in cardiac arrest survivors. Methods Using the Nationwide Readmissions Database, we identified 353,379 adult cardiac arrest index hospitalizations and discharges using the International Classification of Diseases, 9th and 10th codes. The primary outcome was 30-day all-cause unplanned readmissions following cardiac arrest discharge. Secondary outcomes included 30-day readmission rates and reasons, including impacts on other organ systems. Results Of 353,379 discharges for cardiac arrest with 30-day readmission, 9,898 (2.80%) received TTM during index hospitalization. TTM implementation was associated with lower 30-day all-cause unplanned readmission rates versus non-recipients (6.30% vs. 9.30%, p < 0.001). During index hospitalization, receiving TTM was also associated with higher rates of AKI (41.12% vs. 37.62%, p < 0.001) and AHF (20.13% vs. 17.30%, p < 0.001). We identified an association between lower rates of 30-day readmission for AKI (18.34% vs. 27.48%, p < 0.05) and trend toward lower AHF readmissions (11.32% vs. 17.97%, p = 0.05) among TTM recipients. Conclusions Our study highlights a possible negative association between TTM and unplanned 30-day readmission in cardiac arrest survivors, thereby potentially reducing the impact and burden of increased short-term readmission in these patients. Future randomized studies are warranted to optimize TTM use during post-arrest care.
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Affiliation(s)
- Justin Mark
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
- Corresponding author at: 3301 College Ave, Fort Lauderdale, FL 33314, United States.
| | - Jose Lopez
- Department of Internal Medicine, HCA Florida Aventura Hospital, FL, United States
| | - Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Joshua Dodge
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Miguel Belaunzaran
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, FL, United States
| | - Fergie Losiniecki
- Division of Clinical Cardiac Electrophysiology, Medical University of South Carolina, SC, United States
| | | | - Mauricio Danckers
- Division of Critical Care, HCA Florida Aventura Hospital, FL, United States
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Mohamed Jiffry MZ, Hassan R, Davis A, Scharf S, Walgamage T, Ahmed-Khan MA, Dandwani M. Sickle Cell Anemia Associated With Increased In-Hospital Mortality in Post-Cardiac Arrest Patients. Cureus 2023; 15:e37987. [PMID: 37223169 PMCID: PMC10202522 DOI: 10.7759/cureus.37987] [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] [Accepted: 04/22/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Sickle cell anemia (SCA) is a hemoglobinopathy that arises from a point mutation in the beta-globin gene, which causes the polymerization of deoxygenated hemoglobin that leads to a wide variety of clinical complications. Deaths in patients with SCA most commonly arise from renal, cardiovascular disease, infections, and stroke. In-hospital cardiac arrest has been found to be more common in older patients and those on ventilatory life support, among others. This study aims to provide more insight into how SCA affects the risk of in-hospital mortality in post-cardiac arrest patients. Methods The National Inpatient Survey database years 2016 to 2019 was utilized. The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10 PCS) codes for cardiopulmonary resuscitation were used to identify in-hospital cardiac arrest (IHCA) patients. ICD-10 Clinical Modification (CM) codes were used to identify SCA and other medical comorbidities. Categorical data was compared using Person's chi-square test, and continuous variables were compared using the independent samples t-test. Multinomial logistic regression was used to study the effects of SCA on post-arrest in-hospital mortality controlling for age, Charlson comorbidity score, and demographic variables. Binomial logistic regression models for dichotomous variables were utilized in the subgroup and secondary outcomes analysis. Results In patients with IHCA, patients who had SCA were found to have a significantly increased risk of in-hospital mortality adjusted for baseline characteristics and Charlson comorbidity score (OR: 1.16, 95% CI: 1.02-1.32, p=0.0025). Patient characteristics most strongly associated with an increased risk of in-hospital mortality in this cohort were found to be Black race (OR: 1.92, 95% CI: 1.87-1.97, p<0.001) and self-payer status (OR: 2.14, 95% CI: 2.06-2.22, p<0.001). Subgroup analysis revealed only patients with sickle cell disease had a statistically significant increased risk of in-hospital mortality in this cohort (OR: 4.41, 95% CI: 3.5-5.55, p<0.001), and patients with sickle cell trait did not. Conclusion In patients with IHCA, SCA is associated with an increased risk of in-hospital mortality. This risk was confined to patients with sickle cell disease and not patients with sickle cell trait.
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Affiliation(s)
| | - Rehana Hassan
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Alexis Davis
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Shelbie Scharf
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | | | - Mohammad A Ahmed-Khan
- Department of Internal Medicine, University of Vermont, Burlington, USA
- Internal Medicine, Danbury Hospital, Danbury, USA
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6
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Zali M, Rahmani A, Powers K, Hassankhani H, Namdar-Areshtanab H, Gilani N. Nurses' experiences of ethical and legal issues in post-resuscitation care: A qualitative content analysis. Nurs Ethics 2023; 30:245-257. [PMID: 36318470 DOI: 10.1177/09697330221133521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. OBJECTIVE To explore nurses' experiences of ethical and legal issues in post-resuscitation care. RESEARCH DESIGN This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. PARTICIPANTS AND RESEARCH CONTEXT In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed by conventional content analysis. ETHICAL CONSIDERATIONS The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. FINDINGS Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. CONCLUSION There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges.
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Affiliation(s)
- Mahnaz Zali
- 48432Tabriz University of Medical Sciences, Iran
| | - Azad Rahmani
- 48432Tabriz University of Medical Sciences, Iran
| | - Kelly Powers
- 14727University of North Carolina at Charlotte, USA
| | | | | | - Neda Gilani
- 48432Tabriz University of Medical Sciences, Iran
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7
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Stasiowski M, Głowacki Ł, Gąsiorek J, Majer D, Niewiadomska E, Król S, Żak J, Missir A, Prof LK, Prof PJ, Grabarek BO. General health condition of patients hospitalized after an incident of in-hospital or out-of hospital sudden cardiac arrest with return of spontaneous circulation. Clin Cardiol 2021; 44:1256-1262. [PMID: 34312887 PMCID: PMC8428004 DOI: 10.1002/clc.23680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) is one of the main reasons for admission to the intensive care unit (ICU), which influences discharge in a good neurological state. Hypothesis To analyze patients who had recovery of spontaneous circulation (ROSC) during hospitalization in the ICU using the Glasgow Outcome Scale (GOS). Methods The study group comprised 78 patients after SCA (35 after out‐of‐hospital cardiac arrest [OHCA] and 43 after in‐hospital cardiac arrest [IHCA]) with ROSC who were admitted to the ICU of Regional Hospital No. 5 in Sosnowiec from January 1, 2016 to December 31, 2016. GOS was used to assess neurological status. Basic anthropological data, with, arterial blood pH, lactate concentration (LAC), and catecholamine treatment were also collected. Results In the study group, 32.1% (n = 25/78) of patients survived until ICU discharge and 30.8% (n = 24/78) until discharge from the hospital. SCA in cardiac mechanism was more common in OHCA than in the IHCA group (OHCA vs. IHCA: 85.7% vs. 62.8%, p = .02). There was no statistically significant difference between the two groups for neurological status assessed using GOS. There was no statistically significant difference between LAC or arterial blood pH and survival to ICU discharge, survival to hospital discharge, or mortality. The need for using catecholamines increased the mortality rate (GOS 1) (p < .001). Conclusions Most patients after RSOC were assigned to a group other than GOS 1, and 25% of all subjects belonged to GOS 4–5. Treatment with catecholamines was more common in patients who do not survive hospital or ICU discharge.
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Affiliation(s)
- Michał Stasiowski
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Łukasz Głowacki
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland
| | - Jakub Gąsiorek
- Students Scientific Society by Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Dominika Majer
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | - Seweryn Król
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jakub Żak
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Anna Missir
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Lech Krawczyk Prof
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Sosnowiec, Poland.,Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Przemysław Jałowiecki Prof
- Department of Emergency Medicine, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Beniamin Oskar Grabarek
- Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, The University of Technology in Katowice, Katowice, Poland
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Association between Novel Marker (Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio, and Delta Neutrophil Index) and Outcomes in Sudden Cardiac Arrest Patients. Emerg Med Int 2021; 2021:6650958. [PMID: 33833877 PMCID: PMC8012140 DOI: 10.1155/2021/6650958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose It is important that clinicians accurately predict the outcome of patients with sudden cardiac arrest (SCA). The complete blood count (CBC) is an easy and inexpensive test that provides information on blood content. Platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and delta neutrophil index (DNI) are relatively novel biomarkers that have been used in the prognosis of various diseases. We aimed to determine the usefulness of PLR, NLR, and DNI in predicting the outcomes of SCA. Materials and Methods This retrospective observational study was performed on patients with SCA. Patients who visited the tertiary university hospital from January 2015 to December 2019 were targeted. The inclusion criteria were all nontraumatic adult out-hospital cardiac arrest patients. We analyzed DNI, PLR, and NLR based on the CBC results of all enrolled patients. The exclusion criteria were as follows: no data on laboratory study, traumatic arrest, age < 18 years, and a history of leukemia, myelodysplastic syndrome, and myelofibrosis. The primary outcome was assessed as return of spontaneous circulation (ROSC), the secondary outcome as survival to discharge, and the tertiary outcome as neurological outcome. Results From January 1, 2015, to December 31, 2019, 739 patients were enrolled. ROSC was seen in 324 patients, of whom 60 had survival to discharge and 24 had good neurological outcome at the time of discharge (cerebral performance categories (CPCs) 1-2). The PLR of the ROSC group was 42.41 (range: 4.21–508.7), which was higher than that of the No-ROSC group (p=0.006). The DNI value of the survival group was 0.00 (range: 0.00–40.9), which was lower than that of the nonsurvival group. Conclusions Patients with SCA and subsequent ROSC had higher PLR and NLR, while those with survival to discharge had lower DNI values than those with nonsurvival to discharge (p=0.005).
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Reyher C, Karst SR, Muellenbach RM, Lotz C, Peivandi AA, Boersch V, Weber K, Gradaus R, Rolfes C. [Extracorporeal cardiopulmonary resuscitation (eCPR) for out-of-hospital cardiac arrest (OHCA) : Retrospective analysis of a load and go strategy under the aspect of golden hour of eCPR]. Anaesthesist 2020; 70:376-382. [PMID: 33258990 DOI: 10.1007/s00101-020-00896-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Survival rates after an out-of-hospital cardiac arrest (OHCA) remain low. Extracorporeal cardiopulmonary resuscitation (eCPR) has been introduced as an attempt to increase survival in selected patients and observational studies have shown promising results. Nevertheless, inclusion criteria and timing of eCPR remain undefined. OBJECTIVE The current study analyzed a load and go strategy with respect to the golden hour of eCPR as a cut-off time for survival and favorable neurological outcome. MATERIAL AND METHODS This retrospective cohort study included 32 patients who underwent eCPR treatment due to an OHCA between January 2017 and September 2019. Routinely taken patient demographic data (age, BMI, sex) were analyzed. The main focus was set on processing times in the preclinical and clinical setting. Time intervals including OHCA until ambulance arrival, time on scene, transportation times and door to eCPR were extracted from emergency medical service (EMS) and resuscitation protocols. Low-flow times, survival and neurological outcome were analyzed. RESULTS The use of eCPR in OHCA was associated with survival to hospital discharge in 28% and a good neurological outcome in 19% of the cases. Both groups (survivor and nonsurvivor) did not differ in patient demographics except for age. Survivors were significantly younger (47 (30-60) vs. 59 (50-68) years, p = 0.035). Processing times as well as low-flow times were not significantly different (OHCA-eCPR survivor 64 (50-87) vs. non-survivor 74 (51-85) min; p-value 0.64); however, median low-flow times were outside the golden hour of eCPR (69 (52-86)). CONCLUSION Despite low-flow times of more than 60 min, eCPR was associated with survival in 28% after OHCA. Hence, exceeding the golden hour of eCPR cannot act as a definitive exclusion criterion for eCPR.
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Affiliation(s)
- Christian Reyher
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ECMO-Zentrum, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland. .,Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Marburg, Deutschland.
| | - Sarah R Karst
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ECMO-Zentrum, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland
| | - Ralf M Muellenbach
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ECMO-Zentrum, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland
| | - Christopher Lotz
- Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Asghar A Peivandi
- Klinik für Herzchirurgie, ECMO-Zentrum, Klinikum Kassel, Kassel, Deutschland
| | - Vincent Boersch
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ECMO-Zentrum, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland
| | - Klaus Weber
- Interdisziplinäre Zentrale Notaufnahme, Klinikum Kassel, Kassel, Deutschland
| | - Rainer Gradaus
- Klinik für Kardiologie, Klinikum Kassel, Kassel, Deutschland
| | - Caroline Rolfes
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ECMO-Zentrum, Klinikum Kassel, Mönchebergstr. 41-43, 34125, Kassel, Deutschland.,Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Marburg, Deutschland
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Mitophagy in the Hippocampus Is Excessive Activated After Cardiac Arrest and Cardiopulmonary Resuscitation. Neurochem Res 2019; 45:322-330. [PMID: 31773373 DOI: 10.1007/s11064-019-02916-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
This study examined the activation of mitophagy following cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) and the relationship between the change with time and apoptosis. MAIN METHODS The male Sprague-Dawley rats were randomized into four groups: Sham group, CPR24h group, CPR48h group, CPR72h group. The rat model of cardiac arrest was established by asphyxiation. We employed western blot to analyze the levels of mitophagy related proteins of hippocampus, JC-1 to detect mitochondrial membrane potential (MMP) and flow cytometry to measure the rate of apoptosis of hippocampal neurons. Moreover, we also intuitively observed the occurrence of mitophagy through electron microscopy. KEY FINDINGS The results showed that the levels of TOMM20 and Tim23 protein were significantly decreased after CPR, which were more remarkable following 72 h of CPR. However, the protein levels of dynamin related protein 1 (Drp1) and cytochrome C (Cyt-c) were strongly up-regulated after CPR. Meanwhile, the hippocampal MMP decreased gradually with time after CPR. Furthermore, we more intuitively verified the activation of mitophagy through electron microscopy. In addition, the rats of apoptosis rate of hippocampus after CPR were significantly increased, which were gradually enhanced over time from 24 h until at least 72 h following CPR. SIGNIFICANCE with the enhancement of mitophagy, the apoptosis of hippocampal neurons was gradually enhanced, which suggested mitophagy may be excessive activated and aggravating brain damage after CA and CPR.
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Demographics and Clinical Features of Postresuscitation Comorbidities in Long-Term Survivors of Out-of-Hospital Cardiac Arrest: A National Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9259182. [PMID: 28286775 PMCID: PMC5327773 DOI: 10.1155/2017/9259182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/26/2016] [Accepted: 01/04/2017] [Indexed: 12/20/2022]
Abstract
The outcome of patients suffering from out-of-hospital cardiac arrest (OHCA) is very poor, and postresuscitation comorbidities increase long-term mortality. This study aims to analyze new-onset postresuscitation comorbidities in patients who survived from OHCA for over one year. The Taiwan National Health Insurance (NHI) Database was used in this study. Study and comparison groups were created to analyze the risk of suffering from new-onset postresuscitation comorbidities from 2011 to 2012 (until December 31, 2013). The study group included 1,346 long-term OHCA survivors; the comparison group consisted of 4,038 matched non-OHCA patients. Demographics, patient characteristics, and risk of suffering comorbidities (using Cox proportional hazards models) were analyzed. We found that urinary tract infections (n = 225, 16.72%), pneumonia (n = 206, 15.30%), septicemia (n = 184, 13.67%), heart failure (n = 111, 8.25%) gastrointestinal hemorrhage (n = 108, 8.02%), epilepsy or recurrent seizures (n = 98, 7.28%), and chronic kidney disease (n = 62, 4.61%) were the most common comorbidities. Furthermore, OHCA survivors were at much higher risk (than comparison patients) of experiencing epilepsy or recurrent seizures (HR = 20.83; 95% CI: 12.24-35.43), septicemia (HR = 8.98; 95% CI: 6.84-11.79), pneumonia (HR = 5.82; 95% CI: 4.66-7.26), and heart failure (HR = 4.88; 95% CI: 3.65-6.53). Most importantly, most comorbidities occurred within the first half year after OHCA.
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Effects of mild and moderate hypothemia therapy on expression of cerebral neuron apoptosis related proteins and glial fiber acidic protein after rat cardio-pulmonary resuscitation. Cell Biochem Biophys 2015; 70:1519-25. [PMID: 25108738 DOI: 10.1007/s12013-014-0087-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To explore the effects of different degrees of hypothermia on brain tissue apoptosis after cardio-pulmonary resuscitation (CPR). Cardiac arrest for 5 min induced by asphyxia method was used to create CPR model. 30 SD rats were randomly divided into control group (normothermia), 33 °C hypothermia group and 30 °C hypothermia group with ten rats in each. Rats in control group received routine treatment at 25 °C room temperature after CPR; Rats in mild hypothermia and moderate hypothermia groups were given hypothermia treatment 0.5 h after CPR. Brain tissue in all groups was taken 24 h after CPR, and immunohistochemistry was used to detect the caspase-3 in cerebral cortex and glial fiber acidic protein (GFAP) expression in astrocyte. Western blotting was used to detect Bcl-2 and Bax protein expression, and histopathological change was observed in brain tissue. Compare to the control group, caspase-3 expression in cerebral neurons in hypothermia group was significantly decreased (p<0.01), which was significantly lower in 30 °C group than that in 33 °C group (p > 0.05); GFAP level in hypothermia groups was significantly increased (p < 0.01), which was higher in 30 °C hypothermia group than that in 33 °C hypothermia group (p < 0.05); Bcl-2 expression level in hypothermia group was significantly increased (p < 0.01), which was higher in 30 °C hypothermia group than that in 33 °C hypothermia group (p < 0.05); The level of Bax had no significant difference among the three groups. Hypothermia-regulated GFAP expression by decreasing caspase-3 expression and increasing Bcl-2 expression to promote brain cell signaling transduction, and further inhibited cell apoptosis and reduced brain injury. Moderate hypothermia therapy is more effective than mild hypothermia in preventing brain injure.
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Cherry BH, Nguyen AQ, Hollrah RA, Williams AG, Hoxha B, Olivencia-Yurvati AH, Mallet RT. Pyruvate stabilizes electrocardiographic and hemodynamic function in pigs recovering from cardiac arrest. Exp Biol Med (Maywood) 2015; 240:1774-84. [PMID: 26088865 DOI: 10.1177/1535370215590821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/05/2015] [Indexed: 11/15/2022] Open
Abstract
Cardiac electromechanical dysfunction may compromise recovery of patients who are initially resuscitated from cardiac arrest, and effective treatments remain elusive. Pyruvate, a natural intermediary metabolite, energy substrate, and antioxidant, has been found to protect the heart from ischemia-reperfusion injury. This study tested the hypothesis that pyruvate-enriched resuscitation restores hemodynamic, metabolic, and electrolyte homeostasis following cardiac arrest. Forty-two Yorkshire swine underwent pacing-induced ventricular fibrillation and, after 6 min pre-intervention arrest, 4 min precordial compressions followed by transthoracic countershocks. After defibrillation and recovery of spontaneous circulation, the pigs were monitored for another 4 h. Sodium pyruvate or NaCl were infused i.v. (0.1 mmol·kg(-1)·min(-1)) throughout precordial compressions and the first 60 min recovery. In 8 of the 24 NaCl-infused swine, the first countershock converted ventricular fibrillation to pulseless electrical activity unresponsive to subsequent countershocks, but only 1 of 18 pyruvate-treated swine developed pulseless electrical activity (relative risk 0.17; 95% confidence interval 0.13-0.22). Pyruvate treatment also lowered the dosage of vasoconstrictor phenylephrine required to maintain systemic arterial pressure at 15-60 min recovery, hastened clearance of excess glucose, elevated arterial bicarbonate, and raised arterial pH; these statistically significant effects persisted up to 3 h after sodium pyruvate infusion, while infusion-induced hypernatremia subsided. These results demonstrate that pyruvate-enriched resuscitation achieves electrocardiographic and hemodynamic stability in swine during the initial recovery from cardiac arrest. Such metabolically based treatment may offer an effective strategy to support cardiac electromechanical recovery immediately after cardiac arrest.
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Affiliation(s)
- Brandon H Cherry
- Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Anh Q Nguyen
- Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Roger A Hollrah
- Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Arthur G Williams
- Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Besim Hoxha
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Albert H Olivencia-Yurvati
- Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Department of Surgery, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
| | - Robert T Mallet
- Department of Integrative Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA Department of Surgery, University of North Texas Health Science Center, Fort Worth, TX 76107-2699, USA
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