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Arslan A, Özkaya ÖG, Aytemiz F, Altay H, Özcan EE, Küçükaksu DS, Bakuy V, Kozan Ö, Pehlivanoğlu S. Oral amiodarone and propranolol in maintenance therapy of postimplantation tachycardia: An observational study. Medicine (Baltimore) 2024; 103:e38839. [PMID: 38996090 PMCID: PMC11245262 DOI: 10.1097/md.0000000000038839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
Left ventricular assist devices (LVADs) are widely used as end-stage therapy in patients with advanced heart failure, whereas implantation increases the risks of development of sustained ventricular tachycardia at the later postimplantation stage. Therefore, this study aimed to evaluate the clinical efficacy of orally administered amiodarone and propranolol in 3 patients with ventricular tachycardia (VT) after LVAD implantation who were resistant to initial anti-antiarrhythmic drugs. This retrospective cohort study consisted of the initial evaluation of the clinical data of 14 adult patients who underwent implantation of LVAD between January 2019 and March 2021. A total of 3 patients with resistant VT were finally included. In all cases, the patients were initially administered amiodarone in the different doses intravenously to stabilize the critical condition, whereas its oral form along with that of propranolol was used as maintenance therapy in the first 2 cases. In the third case, amiodarone was withdrawn because of the risk of development of hyperthyroidism, while oral propranolol was used in the treatment. The assessment in the 16-month follow-up period after discharge did not show presence of non-sustained and sustained VT in all 3 cases. In the ventricular arrhythmia-free group, the total mortality rate within the follow-up period was 11.1 ± 7.78 months in the 3 patients. We suggest that maintenance oral therapy of propranolol and amiodarone can significantly decrease the risks of complications in patients with VT after implantation of ventricular assist device in the long term.
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Affiliation(s)
- Abdulla Arslan
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Öykü Gülmez Özkaya
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Fatih Aytemiz
- Cardiology Department, Manisa State Hospital, Manisa, Turkey
| | - Hakan Altay
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Emin Evren Özcan
- Cardiology Department, Dokuz Eylül University Izmir Medical and Research Center, Balçova/Izmir, Turkey
| | - Deniz Süha Küçükaksu
- Cardiovascular Surgery Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Vedat Bakuy
- Cardiovascular Surgery Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Ömer Kozan
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
| | - Seçkin Pehlivanoğlu
- Cardiology Department, Baskent University Istanbul Medical and Research Center, Altunizade/Istanbul, Turkey
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Stupca K, Scaturo N, Shomo E, King T, Frank M. Esmolol, vector change, and dose-capped epinephrine for prehospital ventricular fibrillation or pulseless ventricular tachycardia. Am J Emerg Med 2023; 64:46-50. [PMID: 36436299 DOI: 10.1016/j.ajem.2022.11.019] [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: 07/31/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest describes a subset of patients who do not respond to standard Advanced Cardiac Life Support (ACLS) interventions and are associated with poor outcomes. Esmolol administration and vector change defibrillation have shown promise in improving outcomes in these patients, however evidence is limited. OBJECTIVES This study compares clinical outcomes between patients with prehospital refractory VF/pVT who received an Emergency Medical Service (EMS) bundle, comprised of esmolol administration, vector change defibrillation, and dose-capped epinephrine at 3 mg, to patients who received standard ACLS interventions. METHODS This multicenter, retrospective, cohort study evaluated medical records between October 18, 2017 and March 15, 2022. Patients were enrolled if they experienced a prehospital cardiac arrest with the rhythm VF or pVT, had received at least three standard defibrillations, at least 3 mg of epinephrine, and 300 mg of amiodarone. Patients who received the EMS bundle after its implementation were compared to patients who received standard ACLS interventions prior to its implementation. The primary outcome was sustained return of spontaneous circulation (ROSC), defined as ROSC lasting 20 min without recurrence of cardiac arrest. Secondary outcomes included the incidence of any ROSC, survival to hospital arrival, survival at hospital discharge, and neurologically intact survival at hospital discharge. RESULTS Eighty-three patients were included in the study. Thirty-six were included in the pre-EMS bundle group and 47 patients were included in the post-EMS bundle group. Patients in the pre-EMS bundle group achieved significantly higher rates of sustained ROSC (58.3% vs 17%, p < 0.001), any ROSC (66.7% vs 19.1%, p < 0.001), and survival to hospital arrival (55.6% vs 17%, p < 0.001). The rates of survival to hospital discharge (16.7% vs 6.4%, p = 0.17) and neurologically intact survival at hospital discharge (5.9% vs 4.3%, p = 1.00) were not significantly different between groups. CONCLUSIONS Patients who received the EMS bundle achieved sustained ROSC significantly less often and were less likely to have pulses at hospital arrival. The incidence of neurologically intact survival was low and similar between groups.
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Affiliation(s)
- Kyle Stupca
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA.
| | - Nicholas Scaturo
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Eileen Shomo
- Department of Pharmaceutical Care Services, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Tonya King
- Research Institute, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA
| | - Marshall Frank
- Emergency Medicine Program, Florida State University, Sarasota Memorial Hospital, 1700 S Tamiami Trl, Sarasota, FL 34239, USA; Sarasota County Fire Department, 1660 Ringling Blvd, Sarasota, FL 34236, USA
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3
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Lian R, Zhang G, Yan S, Sun L, Gao W, Yang J, Li G, Huang R, Wang X, Liu R, Cao G, Wang Y, Zhang G. The first case series analysis on efficacy of esmolol injection for in-hospital cardiac arrest patients with refractory shockable rhythms in China. Front Pharmacol 2022; 13:930245. [PMID: 36249764 PMCID: PMC9561246 DOI: 10.3389/fphar.2022.930245] [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: 04/27/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background: This study assessed the effects of esmolol injection in patients with in-hospital cardiac arrest (IHCA) with refractory ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT). Methods: From January 2018 to December 2021, 29 patients with IHCA with refractory shockable rhythm were retrospectively reviewed. Esmolol was administered after advanced cardiovascular life support (ACLS)-directed procedures, and outcomes were assessed. Results: Among the 29 cases, the rates of sustained return of spontaneous circulation (ROSC), 24-h ROSC, and 72-h ROSC were 79%, 62%, and 59%, respectively. Of those patients, 59% ultimately survived to discharge. Four patients with cardiac insufficiency died. The duration from CA to esmolol infusion was significantly shorter for patients in the survival group (SG) than for patients in the dead group (DG) (12 min, IQR: 8.5–19.5 vs. 23.5 min, IQR: 14.4–27 min; p = 0.013). Of those patients, 76% (22 of 29) started esmolol administration after the second dose of amiodarone. No significant difference was observed in the survival rate between this group and groups administered an esmolol bolus simultaneously or before the second dose of amiodarone (43% vs. 64%, p = 0.403). Of those patients, 31% (9 of 29) were administered an esmolol bolus for defibrillation attempts ≤ 5, while the remaining 69% of patients received an esmolol injection after the fifth defibrillation attempt. No significant differences were observed in the rates of ≥ 24-h ROSC (67% vs. 60%, p = 0.73), ≥ 72-h ROSC (67% vs. 55%, p = 0.56), and survival to hospital discharge (67% vs. 55%, p = 0.56) between the groups administered an esmolol bolus for defibrillation attempts ≤ 5 and defibrillation attempts > 5. Conclusion: IHCA patients with refractory shockable rhythms receiving esmolol bolus exhibited a high chance of sustained ROSC and survival to hospital discharge. Patients with end-stage heart failure tended to have attenuated benefits from beta-blockers. Further large-scale, prospective studies are necessary to determine the effects of esmolol in patients with IHCA with refractory shockable rhythms.
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Affiliation(s)
- Rui Lian
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Guochao Zhang
- General Surgery Department, China-Japan Friendship Hospital, Beijing, China
| | - Shengtao Yan
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Lichao Sun
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Wen Gao
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Jianping Yang
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Guonan Li
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
| | - Rihong Huang
- Cardiac Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaojie Wang
- Cardiac Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Renyang Liu
- Intensive Care Unit, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Guangqing Cao
- Cardiac Surgery Department, Qilu Hospital of ShanDong University, Jinan, China
| | - Yong Wang
- Cardiac Care Unit, XiangTan Central Hospital, Xiangtan, China
| | - Guoqiang Zhang
- Emergency Department, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Guoqiang Zhang,
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Wada T, Hagiwara-Nagasawa M, Kambayashi R, Goto A, Chiba K, Nunoi Y, Izumi-Nakaseko H, Koga T, Matsumoto A, Nakazato Y, Lurie KG, Sugiyama A. Effects of Cardiac Massage and β-Blocker Pretreatment on the Success Rate of Cardiopulmonary Resuscitation Assessed by the Canine Ischemia/Reperfusion-Induced Ventricular Fibrillation Model. Circ J 2021; 85:1885-1891. [PMID: 33762525 DOI: 10.1253/circj.cj-20-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Effects of rapid electrical defibrillation and β-blockade on coronary ischemia/reperfusion-induced ventricular fibrillation (VF) during cardiopulmonary resuscitation (CPR) remain unknown.Methods and Results:After induction of VF by 30 min of ischemia followed by reperfusion, animals were treated with defibrillation alone (Group A, n=13), 2 min of open-chest cardiac massage followed by defibrillation (Group B, n=11), or the same therapy to Group B with propranolol (1 mg/kg, i.v.) treatment before ischemia/reperfusion (Group C, n=11). If return of spontaneous circulation (ROSC) was not attained, each therapy was repeated ≤3 times (Set-1). When ROSC was not obtained within Set-1, cardiac massage was applied to all animals followed by defibrillation, which was repeated ≤3 times (Set-2). ROSC after Set-1 was 8% in Group A, 82% in Group B and 82% in Group C, whereas that after Set-2 was 62% in Group A, 100% in Group B and 82% in Group C. Each animal with ROSC in Groups A (n=8) and B (n=11) showed sinus rhythm, whereas those in Group C (n=9) had sinus rhythm (n=5), atrial fibrillation (n=1), accelerated idioventricular rhythm (n=2) and atrioventricular block (n=1). Post ROSC heart rate and mean arterial pressure were significantly lower in Group C. CONCLUSIONS Cardiac massage increased the likelihood of ROSC vs. rapid defibrillation, but β-blocker pretreatment may worsen hemodynamics and electrical stability after ROSC.
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Affiliation(s)
- Takeshi Wada
- Department of Pharmacology, Faculty of Medicine, Toho University.,Department of Cardiology, Juntendo University Urayasu Hospital
| | | | | | - Ai Goto
- Department of Pharmacology, Faculty of Medicine, Toho University
| | - Koki Chiba
- Department of Pharmacology, Faculty of Medicine, Toho University
| | - Yoshio Nunoi
- Department of Pharmacology, Faculty of Medicine, Toho University
| | | | - Tadashi Koga
- Department of Pharmacology, Faculty of Medicine, Toho University
| | - Akio Matsumoto
- Department of Aging Pharmacology, Faculty of Medicine, Toho University
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University Urayasu Hospital
| | - Keith G Lurie
- Department of Emergency Medicine, University of Minnesota Medical School
| | - Atsushi Sugiyama
- Department of Pharmacology, Faculty of Medicine, Toho University.,Department of Aging Pharmacology, Faculty of Medicine, Toho University.,Yamanashi Research Center of Clinical Pharmacology, University of Yamanashi
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Refractory Ventricular Fibrillation Treated with Double Simultaneous Defibrillation: Pilot Study. Emerg Med Int 2020; 2020:5470912. [PMID: 32566304 PMCID: PMC7273448 DOI: 10.1155/2020/5470912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/21/2020] [Accepted: 05/04/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Refractory shockable rhythm has a high mortality rate and poor neurological outcome. Treatments for refractory shockable rhythm presenting after defibrillation and medical treatment are not definite. We conducted research on the application of double simultaneous defibrillation (DSiD) for refractory shockable rhythms. Methods This is a retrospective pilot study performed using medical records from 1 January 2016 to 31 December 2017. The prephase was from January to December 2016. The post-phase was from January to December 2017. During the prephase, we conducted conventional defibrillation with one defibrillator, and during the post-phase, we conducted DSiD using two defibrillators. Primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and good neurological outcome at 12 months. Statistical analysis was conducted using Fisher's exact test. Data were regarded statistically significant when p < 0.05. Result A total of 38 patients were included. Twenty-one patients underwent conventional defibrillation, and 17 underwent DSiD. The DSiD group had a higher survival to admission rate (14/17 (82.4%) vs. 6/21 (28.6%), p=0.001) and showed a trend for higher survival to discharge (7/17 (41.2%) vs. 3/21 (14.3%), p=0.078). Good neurological outcome at 12 months of the DSiD group was higher than that of the conventional defibrillation group, but the difference was not statistically significant (5/17 (29.4%) vs 2/21 (9.5%), p=0.207). Conclusion In patients with refractory shockable rhythms, DSiD has increased survival to hospital admission and a trend of increased survival to hospital discharge. However, DSiD did not improve neurological outcome at 12 months.
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6
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Szabó Z, Ujvárosy D, Ötvös T, Sebestyén V, Nánási PP. Handling of Ventricular Fibrillation in the Emergency Setting. Front Pharmacol 2020; 10:1640. [PMID: 32140103 PMCID: PMC7043313 DOI: 10.3389/fphar.2019.01640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%–10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tamás Ötvös
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
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Gottlieb M, Dyer S, Peksa GD. Beta-blockade for the treatment of cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia: A systematic review and meta-analysis. Resuscitation 2020; 146:118-125. [DOI: 10.1016/j.resuscitation.2019.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/08/2019] [Accepted: 11/20/2019] [Indexed: 12/29/2022]
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8
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Kontogiannis C, Georgiopoulos G, Papageorgiou C, Anninos H, Tampakis K, Kosmopoulos M, Vasileiou P, Kanakakis I, Paraskevaidis I, Chatzidou S. A Recalcitrant Electrical Storm and Implantable Defibrillator Exhaustion: Treatment Implications According to and Beyond Guidelines. JACC Case Rep 2019; 1:602-606. [PMID: 34316888 PMCID: PMC8288686 DOI: 10.1016/j.jaccas.2019.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/10/2019] [Accepted: 09/04/2019] [Indexed: 12/07/2022]
Abstract
A 60-year-old patient presented with recalcitrant electrical storm (ES). Mild sedation and initial antiarrhythmic combination of esmolol and amiodarone did not affect the intensity of ES, which resulted in battery exhaustion. Oral propranolol in addition to intravenous amiodarone might be preferred in hemodynamically stable patients before interventional therapies. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Christos Kontogiannis
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Papageorgiou
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Hector Anninos
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tampakis
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Kosmopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Vasileiou
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Kanakakis
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Paraskevaidis
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Chatzidou
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Triple-sequential defibrillation for refractory ventricular fibrillation in a 24-year-old male out of hospital cardiac arrest. CAN J EMERG MED 2019; 21:809-811. [DOI: 10.1017/cem.2019.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SUMMARYRefractory ventricular fibrillation encountered during cardiac arrest has a mortality rate of 97%.1 As per the advanced cardiac life support (ACLS) guidelines, the management algorithm of ventricular fibrillation consists of chest compressions, epinephrine, defibrillation, and anti-arrhythmics.2 There have been reports describing the use of the fast-acting selective β-blocker, esmolol, and dual-sequential defibrillation in the management of ventricular fibrillation that is refractory to standard ACLS. We present a case of a 24-year-old male who had an out-of-hospital cardiac arrest, with refractory ventricular fibrillation despite high-quality cardiopulmonary resuscitation (CPR) and ACLS management. Along with standard ACLS, triple-sequential defibrillation was used to achieve return of spontaneous circulation (ROSC) after 82 minutes of downtime. An electrocardiogram (ECG) after ROSC showed an ST-elevation myocardial infarction (MI), and the patient underwent angiography showing a 100% occlusion of his left anterior descending artery. Following management of his coronary artery disease, he was discharged from the hospital 16 days later and was neurologically intact.
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Bougouin W, Dumas F, Lamhaut L, Marijon E, Carli P, Combes A, Pirracchio R, Aissaoui N, Karam N, Deye N, Sideris G, Beganton F, Jost D, Cariou A, Jouven X, Adnet F, Agostinucci JM, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Benhamou D, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Crahes M, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Dhonneur G, Diehl JL, Dinanian S, Domanski L, Dreyfuss D, Duboc D, Dubois-Rande JL, Dumas F, Empana JP, Extramiana F, Fartoukh M, Fieux F, Gabbas M, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Hidden Lucet F, Jabre P, Jacob L, Joseph L, Jost D, Jouven X, Karam N, Kassim H, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt CE, Maltret A, Mansencal N, Mansouri N, Marijon E, Marty J, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira JP, Monnet X, Narayanan K, Ngoyi N, Perier MC, Piot O, Pirracchio R, Plaisance P, Plu I, Raux M, Revaux F, Ricard JD, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharifzadehgan A, Sideris G, Spaulding C, Teboul JL, Timsit JF, Tourtier JP, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. Eur Heart J 2019; 41:1961-1971. [DOI: 10.1093/eurheartj/ehz753] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/26/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes.
Methods and results
We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002).
Conclusions
In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.
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Affiliation(s)
- Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Medical-Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Pierre Carli
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Intensive Care Unit - SAMU 75, Necker-Enfants-Malades Hospital, APHP, 149 Rue de Sèvres, 75015 Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Romain Pirracchio
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Surgical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nadia Aissaoui
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical ICU, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Nicolas Deye
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Medical ICU, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Georgios Sideris
- Cardiology Department, Lariboisière Hospital, AP-HP, 2 Rue Ambroise Paré, 75010 Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Brigade de Sapeurs Pompiers de Paris (BSPP), 1 Place Jules Renard, 75017 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- AfterROSC network, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Medical Intensive Care Unit, Cochin Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, 56 rue Leblanc, 75787 Paris, France
- Paris Sudden Death Expertise Center, 56 rue Leblanc, 75787 Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, 12 Rue de l'École de Médecine, 75006 Paris, France
- Cardiology Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015 Paris, France
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Chatzidou S, Kontogiannis C, Tsilimigras DI, Georgiopoulos G, Kosmopoulos M, Papadopoulou E, Vasilopoulos G, Rokas S. Propranolol Versus Metoprolol for Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillator. J Am Coll Cardiol 2019; 71:1897-1906. [PMID: 29699616 DOI: 10.1016/j.jacc.2018.02.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/29/2018] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Electrical storm (ES), characterized by unrelenting recurrences of ventricular arrhythmias, is observed in approximately 30% of patients with implantable cardioverter-defibrillators (ICDs) and is associated with high mortality rates. OBJECTIVES Sympathetic blockade with β-blockers, usually in combination with intravenous (IV) amiodarone, have proved highly effective in the suppression of ES. In this study, we compared the efficacy of a nonselective β-blocker (propranolol) versus a β1-selective blocker (metoprolol) in the management of ES. METHODS Between 2011 and 2016, 60 ICD patients (45 men, mean age 65.0 ± 8.5 years) with ES developed within 24 h from admission were randomly assigned to therapy with either propranolol (160 mg/24 h, Group A) or metoprolol (200 mg/24 h, Group B), combined with IV amiodarone for 48 h. RESULTS Patients under propranolol therapy in comparison with metoprolol-treated individuals presented a 2.67 times decreased incidence rate (incidence rate ratio: 0.375; 95% confidence interval: 0.207 to 0.678; p = 0.001) of ventricular arrhythmic events (tachycardia or fibrillation) and a 2.34 times decreased rate of ICD discharges (incidence rate ratio: 0.428; 95% CI: 0.227 to 0.892; p = 0.004) during the intensive care unit (ICU) stay, after adjusting for age, sex, ejection fraction, New York Heart Association functional class, heart failure type, arrhythmia type, and arrhythmic events before ICU admission. At the end of the first 24-h treatment period, 27 of 30 (90.0%) patients in group A, while only 16 of 30 (53.3%) patients in group B were free of arrhythmic events (p = 0.03). The termination of arrhythmic events was 77.5% less likely in Group B compared with Group A (hazard ratio: 0.225; 95% CI: 0.112 to 0.453; p < 0.001). Time to arrhythmia termination and length of hospital stay were significantly shorter in the propranolol group (p < 0.05 for both). CONCLUSIONS The combination of IV amiodarone and oral propranolol is safe, effective, and superior to the combination of IV amiodarone and oral metoprolol in the management of ES in ICD patients.
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Affiliation(s)
- Sofia Chatzidou
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Kosmopoulos
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elektra Papadopoulou
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Vasilopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Rokas
- Department of Clinical Therapeutics, "Alexandra" Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Hwang CW, Gamble G, Marchick M, Becker TK. A case of refractory ventricular fibrillation successfully treated with low-dose esmolol. BMJ Case Rep 2019; 12:12/3/e228208. [PMID: 30852502 DOI: 10.1136/bcr-2018-228208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Current advanced cardiac life support (ACLS) guidelines for the management of ventricular fibrillation (VF) and pulseless ventricular tachycardia is defibrillation. However, refractory VF, which is defined as VF that persists despite three defibrillation attempts, is challenging for all ACLS providers; the best resuscitation strategy for patients that persist in refractory VF remains unclear. We report on a 51-year-old man who presented to the emergency department with chest pain and subsequently went into witnessed VF cardiac arrest. Despite standard ACLS management consisting of high-quality cardiopulmonary resuscitation, serial epinephrine and serial defibrillation, the return of spontaneous circulation (ROSC) was unable to be achieved. Double sequential defibrillation (DSD) was attempted multiple times unsuccessfully. After administration of low-dose esmolol, he immediately achieved ROSC. DSD and β-blockade are increasingly recognised in the literature and practice for refractory VF. However, to the best of our knowledge, this is the first case of refractory VF that responded to low-dose esmolol β-blockade.
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Affiliation(s)
- Charles W Hwang
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Ginger Gamble
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael Marchick
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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14
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Tian F, Liu T, Xu G, Li D, Ghazi T, Shick T, Sajjad A, Wang MM, Farrehi P, Borjigin J. Adrenergic Blockade Bi-directionally and Asymmetrically Alters Functional Brain-Heart Communication and Prolongs Electrical Activities of the Brain and Heart during Asphyxic Cardiac Arrest. Front Physiol 2018; 9:99. [PMID: 29487541 PMCID: PMC5816970 DOI: 10.3389/fphys.2018.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/29/2018] [Indexed: 01/12/2023] Open
Abstract
Sudden cardiac arrest is a leading cause of death in the United States. The neurophysiological mechanism underlying sudden death is not well understood. Previously we have shown that the brain is highly stimulated in dying animals and that asphyxia-induced death could be delayed by blocking the intact brain-heart neuronal connection. These studies suggest that the autonomic nervous system plays an important role in mediating sudden cardiac arrest. In this study, we tested the effectiveness of phentolamine and atenolol, individually or combined, in prolonging functionality of the vital organs in CO2-mediated asphyxic cardiac arrest model. Rats received either saline, phentolamine, atenolol, or phentolamine plus atenolol, 30 min before the onset of asphyxia. Electrocardiogram (ECG) and electroencephalogram (EEG) signals were simultaneously collected from each rat during the entire process and investigated for cardiac and brain functions using a battery of analytic tools. We found that adrenergic blockade significantly suppressed the initial decline of cardiac output, prolonged electrical activities of both brain and heart, asymmetrically altered functional connectivity within the brain, and altered, bi-directionally and asymmetrically, functional, and effective connectivity between the brain and heart. The protective effects of adrenergic blockers paralleled the suppression of brain and heart connectivity, especially in the right hemisphere associated with central regulation of sympathetic function. Collectively, our results demonstrate that blockade of brain-heart connection via alpha- and beta-adrenergic blockers significantly prolonged the detectable activities of both the heart and the brain in asphyxic rat. The beneficial effects of combined alpha and beta blockers may help extend the survival of cardiac arrest patients.
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Affiliation(s)
- Fangyun Tian
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Tiecheng Liu
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Gang Xu
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Duan Li
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Talha Ghazi
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Trevor Shick
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Azeem Sajjad
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Michael M Wang
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Peter Farrehi
- Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Jimo Borjigin
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States.,Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States.,Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, United States
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Lee YH, Lee KJ, Min YH, Ahn HC, Sohn YD, Lee WW, Oh YT, Cho GC, Seo JY, Shin DH, Park SO, Park SM. Refractory ventricular fibrillation treated with esmolol. Resuscitation 2016; 107:150-5. [DOI: 10.1016/j.resuscitation.2016.07.243] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/17/2016] [Accepted: 07/24/2016] [Indexed: 12/01/2022]
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16
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Should we "block" refractory ventricular fibrillation? Resuscitation 2016; 107:A9-A10. [PMID: 27591055 DOI: 10.1016/j.resuscitation.2016.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
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ZOERNER F, LENNMYR F, WIKLUND L, MARTIJN C, SEMENAS E. Milrinone and esmolol decrease cardiac damage after resuscitation from prolonged cardiac arrest. Acta Anaesthesiol Scand 2015; 59:465-74. [PMID: 25790148 DOI: 10.1111/aas.12480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term survival after cardiac arrest (CA) due to shock-refractory ventricular fibrillation (VF) is low. Clearly, there is a need for new pharmacological interventions in the setting of cardiopulmonary resuscitation (CPR) to improve outcome. Here, hemodynamic parameters and cardiac damage are compared between the treatment group (milrinone, esmolol and vasopressin) and controls (vasopressin only) during resuscitation from prolonged CA in piglets. METHODS A total of 26 immature male piglets were subjected to 12-min VF followed by 8-min CPR. The treatment group (n=13) received i.v. (intravenous) boluses vasopressin 0.4 U/kg, esmolol 250 μg/kg and milrinone 25 μg/kg after 13 min, followed by i.v. boluses esmolol 375 μg/kg and milrinone 25 μg/kg after 18 min and continuous esmolol 15 μg/kg/h infusion during 180 min reperfusion, whereas controls (n=13) received equal amounts of vasopressin and saline. A 200 J monophasic counter-shock was delivered to achieve resumption of spontaneous circulation (ROSC) after 8 min CPR. If ROSC was not achieved, another 200 J defibrillation and bolus vasopressin 0.4 U/kg would be administered in both groups. Direct current shocks at 360 J were applied as one shot per minute over maximally 5 min. Hemodynamic variables and troponin I as a marker of cardiac injury were recorded. RESULTS Troponin I levels after 180 min reperfusion were lower in the treatment group than in controls (P<0.05). The treatment group received less norepinephrine (P<0.01) and had greater diuresis (P<0.01). There was no difference in survival between groups. CONCLUSION The combination of milrinone, esmolol and vasopressin decreased cardiac injury compared with vasopressin alone.
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Affiliation(s)
- F. ZOERNER
- Department of Surgical Sciences; Section of Anesthesiology and Intensive Care Medicine; Uppsala University Hospital; Uppsala Sweden
- Department of Operative and Intensive Care Medicine; Hallands Hospital Halmstad; Halmstad Sweden
| | - F. LENNMYR
- Uppsala University Hospital; Department of Surgical Sciences; Section of Cardiothoracic Anesthesiology and Intensive Care Medicine; Uppsala Sweden
| | - L. WIKLUND
- Department of Surgical Sciences; Section of Anesthesiology and Intensive Care Medicine; Uppsala University Hospital; Uppsala Sweden
| | - C. MARTIJN
- Department of Chemistry-BMC; Uppsala University; Uppsala Sweden
| | - E. SEMENAS
- Department of Surgical Sciences; Section of Anesthesiology and Intensive Care Medicine; Uppsala University Hospital; Uppsala Sweden
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Driver BE, Debaty G, Plummer DW, Smith SW. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation 2014; 85:1337-41. [DOI: 10.1016/j.resuscitation.2014.06.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/24/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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Mamou Z, Chahine M, Rhondali O, Dehina L, Chevalier P, Descotes J, Bui-Xuan B, Romestaing C, Timour Q. Effects of amlodipine and perindoprilate on the structure and function of mitochondria in ventricular cardiomyocytes during ischemia-reperfusion in the pig. Fundam Clin Pharmacol 2014; 29:21-30. [DOI: 10.1111/fcp.12070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/27/2014] [Accepted: 02/20/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Zahida Mamou
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
| | - Mohamed Chahine
- Centre de recherche en neuroscience; Institut universitaire en santé mentale de Québec; Québec G1J 2G3 Canada
| | - Ossam Rhondali
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
| | - Leila Dehina
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
| | - Philippe Chevalier
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
| | - Jacques Descotes
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
- Poison Center and Pharmacovigilance Department; 162 Ave Lacassagne 69003 Lyon France
| | - Bernard Bui-Xuan
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
| | - Caroline Romestaing
- Laboratoire d'Ecologie des Hydrosystèmes Naturels et Anthropisés; CNRS UMR 5023; Ave Albert Einstein 69100 Villeurbanne France
| | - Quadiri Timour
- EA 4612; Laboratory of Medical Pharmacology; Claude Bernard University; 69373 Lyon France
- Poison Center and Pharmacovigilance Department; 162 Ave Lacassagne 69003 Lyon France
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Ji XF, Shuo Wang, Yang L, Li CS. Impaired β-adrenergic receptor signalling in post-resuscitation myocardial dysfunction. Resuscitation 2012; 83:640-4. [DOI: 10.1016/j.resuscitation.2011.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/09/2011] [Accepted: 11/10/2011] [Indexed: 01/08/2023]
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Beta-blockade causes a reduction in the frequency spectrum of VF but improves resuscitation outcome: A potential limitation of quantitative waveform measures. Resuscitation 2012; 83:511-6. [DOI: 10.1016/j.resuscitation.2011.09.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/10/2011] [Accepted: 09/26/2011] [Indexed: 11/21/2022]
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de Oliveira FC, Feitosa-Filho GS, Ritt LEF. Use of beta-blockers for the treatment of cardiac arrest due to ventricular fibrillation/pulseless ventricular tachycardia: a systematic review. Resuscitation 2012; 83:674-83. [PMID: 22306254 DOI: 10.1016/j.resuscitation.2012.01.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 01/19/2012] [Accepted: 01/27/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Advanced Life Support guidelines recommend the use of epinephrine during Cardiopulmonary Resuscitation (CPR), as to increase coronary blood flow and perfusion pressure through its alpha-adrenergic peripheral vasoconstriction, allowing minimal rises in coronary perfusion pressure to make defibrillation possible. Contrasting to these alpha-adrenergic effects, epinephrine's beta-stimulation may have deleterious effects through an increase in myocardial oxygen consumption and a reduction of subendocardial perfusion, leading to postresuscitation cardiac dysfunction. OBJECTIVE The present paper consists of a systematic review of the literature regarding the use of beta-blockade in cardiac arrest due to ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). METHODS Studies were identified through MEDLINE electronic databases research and were included those regarding the use of beta-blockade during CPR. RESULTS Beta-blockade has been extensively studied in animal models of CPR. These studies not only suggest that beta-blockade could reduce myocardial oxygen requirements and the number of shocks necessary for defibrillation, but also improve postresuscitation myocardial function, diminish arrhythmia recurrences and prolong survival. A few case reports described successful beta-blockade use in patients, along with two prospective human studies, suggesting that it could be safe and effectively used during cardiac arrest in humans. CONCLUSION Even though the existing literature points toward a beneficial effect of beta-blockade in patients presenting with cardiac arrest due to VF/pulseless VT, high quality human trials are still lacking to answer this question definitely.
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Affiliation(s)
- Felipe Carvalho de Oliveira
- Escola Bahiana de Medicina e Saúde Pública, Rua Frei Henrique, n° 08, Nazaré, CEP: 40050-420, Salvador, BA, Brazil
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Charalampopoulos AF, Nikolaou NI. Emerging pharmaceutical therapies in cardiopulmonary resuscitation and post-resuscitation syndrome. Resuscitation 2011; 82:371-7. [DOI: 10.1016/j.resuscitation.2010.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/05/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
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Youngquist ST, Shah A, McClung C, Thomas JL, Rosborough JP, Niemann JT. Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model. Resuscitation 2011; 82:228-31. [PMID: 21051132 PMCID: PMC3026096 DOI: 10.1016/j.resuscitation.2010.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/18/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Coronary perfusion pressure (CPP) during resuscitation from cardiac arrest has been shown to correlate with return of spontaneous circulation. Adrenergic blockade of beta-1 and alpha-1 receptors is common in the long-term management of ischemic heart disease and congestive heart failure. We sought to compare the CPP response to vasopressin vs. epinephrine in a swine model of cardiac arrest following pre-arrest adrenergic blockade. METHODS Eight anesthetized and instrumented swine were administered 0.1mg epinephrine and arterial pressure and heart rate response were measured. An infusion of labetalol was then initiated and animals periodically challenged with epinephrine until adrenergic blockade was confirmed. The left anterior descending coronary artery was occluded to produce ventricular fibrillation (VF). After 7min of untreated VF, mechanical chest compressions were initiated. After 1min of compressions, 1mg epinephrine was given while CPP was recorded. When CPP values had returned to pre-epinephrine levels, 40U of bolus vasopressin was given. Differences in CPP (post-vasopressor-pre-vasopressor) were compared within animals for the epinephrine and vasopressin response and with eight, non-adrenergically blocked, historical controls using Bayesian statistics with a non-informative prior. RESULTS The CPP response following epinephrine was 15.1mmHg lower in adrenergically blocked animals compared to non-adrenergically blocked animals (95% Highest Posterior Density [HPD] 2.9-27.2mmHg lower). CPP went up 18.4mmHg more following vasopressin when compared to epinephrine (95% HPD 8.2-29.1mmHg). The posterior probability of a higher CPP response from vasopressin (vs. epinephrine) in these animals was 0.999. CONCLUSIONS Pre-arrest adrenergic blockade blunts the CPP response to epinephrine. Superior augmentation of CPP is attained with vasopressin under these conditions.
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Affiliation(s)
- Scott T Youngquist
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Uraoka M, Nakajima Y, Kurita T, Suzuki A, Takata K, Sato S. Landiolol, an ultra short acting β1-blocker, improves pulmonary edema after cardiopulmonary resuscitation with epinephrine in rats. J Anesth 2009; 24:67-72. [DOI: 10.1007/s00540-009-0834-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 08/20/2009] [Indexed: 11/29/2022]
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Dichtwald S, Matot I, Einav S. Improving the outcome of in-hospital cardiac arrest: the importance of being EARNEST. Semin Cardiothorac Vasc Anesth 2009; 13:19-30. [PMID: 19223286 DOI: 10.1177/1089253209332212] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiopulmonary resuscitation techniques were introduced more than 50 years ago, yet the rate of survival from cardiac arrest, particularly in the hospital setting, remains dismally low. This article reviews the prevalence, etiology, and outcome of in-hospital cardiac arrest, with a focus on the determinants of outcome that are amenable to improvement. These include principally components of basic life support that may be supported by either prompting or mechanical assistance (eg, chest compression, ventilation, and defibrillation). Also reviewed are preevent and postevent effectors such as medical staff skills and recognition of impending arrest, induction of mild hypothermia, and stabilization after return of spontaneous circulation.
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Affiliation(s)
- Sara Dichtwald
- Department of Anesthesiology and Critical Care Medicine, Sourasky Medical Center affiliated with the Tel Aviv University, Tel Aviv, Israel
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In this issue. Resuscitation 2007. [DOI: 10.1016/j.resuscitation.2007.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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