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Bijl I, Vianen NJ, Van Lieshout EMM, Beekers CHJ, Van Der Waarden NWPL, Pekbay B, Maissan IM, Verhofstad MHJ, Van Vledder MG. Emergency reflex action drill for traumatic cardiac arrest in a simulated pre-hospital setting; a one-group pre-post intervention study. Intensive Crit Care Nurs 2024; 84:103731. [PMID: 38823272 DOI: 10.1016/j.iccn.2024.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/06/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Emergency Reflex Action Drills (ERADs) are meant to decrease stress-associated cognitive demand in high urgency situations. The aim of this study was to develop and test an ERAD for witnessed traumatic cardiac arrest (TCA), an event in which potentially reversible causes need to be systematically addressed and treated in a short period of time. We hypothesize that this ERAD (the TCA-Drill) helps ground Emergency Medical Services (EMS) nurses in overcoming performance decline during this specific high-pressure situation. METHODS This was a prospective, experimental one-group pre-post intervention study. Ground EMS nurses participated in a session of four simulated scenarios, with an in-between educational session to teach the TCA-Drill. Scenarios were video recorded, after which adherence and time differences were analyzed. Self-confidence on clinical practice was measured before and after the scenarios. RESULTS Twelve ground EMS nurses participated in this study. Overall median time to address reversible causes of TCA decreased significantly using the TCA-Drill (132 vs. 110 s; p = 0.030) compared with the conventional ALS strategy. More specifically, participants adhering to the TCA-Drill showed a significantly lower time needed for hemorrhage control (58 vs. 37 s; p = 0.012). Eight of 12 (67 %) ground EMS nurses performed the ERAD without protocol deviations. Reported self-confidence significantly increased on 11 of the 13 surveyed items. CONCLUSIONS The use of an ERAD for TCA (the TCA-Drill) significantly reduces the time to address reversible causes for TCA without delaying chest compressions in a simulated environment and can be easily taught to ground EMS nurses and increases self-confidence. IMPLICATIONS FOR CLINICAL PRACTICE The use of an ERAD for TCA (the TCA-Drill can significantly reduce the time to address reversible causes for TCA without delaying chest compression. This drill can be easily taught to ground EMS nurses and increases their self-confidence in addressing TCA-patients.
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Affiliation(s)
- Irene Bijl
- Nursing Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands; Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Niek J Vianen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Christian H J Beekers
- Regional Ambulance Care Provider, Brabant Midden West Noord, 's Hertogenbosch, The Netherlands
| | | | - Begüm Pekbay
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Iscander M Maissan
- Department of Anesthesiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands
| | - Mark G Van Vledder
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam The Netherlands.
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Fernández-Méndez M, Barcala-Furelos R, Otero-Agra M, Bierens J. Increasing ventilation in drowning resuscitation - A cross-over randomized simulation study of ventilation during automated external defibrillator analysis pauses. Resusc Plus 2024; 19:100674. [PMID: 38873276 PMCID: PMC11170470 DOI: 10.1016/j.resplu.2024.100674] [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: 02/19/2024] [Revised: 05/09/2024] [Accepted: 05/19/2024] [Indexed: 06/15/2024] Open
Abstract
Objective The aim of this study was to analyze the feasibility of a new resuscitation strategy in which breaths are provided during automated external defibrillator (AED) rhythm analysis, and to evaluate its impact on chest compressions (CC) quality and the peri-analysis time. Method A randomized simulation study, comparing two cardiopulmonary resuscitations strategies, has been conducted: the standard strategy (S1) with strategy involving ventilation during AED analysis (S2). Thirty lifeguards have performed both strategies in a cross-over study design during 10 min of CPR. Results The number of ventilations per 10 min increases from 47 (S1) to 72 (S2) (p < 0.001). This results in the delivery of an additional 17.1 L of insufflated air in S2 compared to S1 (p < 0.001). There have been no significant changes in frequency and total number of CC. These findings correspond to a reduction of the non-ventilation period from 176 s (S1) to 48 s (S2). Conclusions This simulation study suggests that it is feasible to increase the number of ventilations during resuscitation following drowning, without affecting the quantity and quality of chest compressions. The results of this study may serve as a foundation for further investigation into optimal ventilation strategies in this context.
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Affiliation(s)
- María Fernández-Méndez
- Faculty of Education and Sport Sciences, REMOSS Research Group, Universidade de Vigo, Pontevedra, Spain
- CLINURSID Research Group, Nursing Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- School of Nursing, Universidade de Vigo, Pontevedra, Spain
| | - Roberto Barcala-Furelos
- Faculty of Education and Sport Sciences, REMOSS Research Group, Universidade de Vigo, Pontevedra, Spain
- CLINURSID Research Group, Nursing Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Faculty of Education and Sports Sciences, University of Vigo, Pontevedra, Spain
| | - Martín Otero-Agra
- Faculty of Education and Sport Sciences, REMOSS Research Group, Universidade de Vigo, Pontevedra, Spain
- School of Nursing, Universidade de Vigo, Pontevedra, Spain
| | - Joost Bierens
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, UK
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Beaulieu J, St-Onge M. Antidote use for cardiac arrest or hemodynamic instability due to cardiac glycoside poisoning: A narrative review. Resusc Plus 2024; 19:100690. [PMID: 39006132 PMCID: PMC11246064 DOI: 10.1016/j.resplu.2024.100690] [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: 04/16/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Cardiac glycosides comprise medications such as digoxin and digitoxin, plants, and even certain toad venoms. Intoxication with cardiac glycosides can lead to hemodynamic instability and cardiac arrest. With this narrative review, our objective was to determine if any therapy used in a near-cardiac arrest state due to cardiac glycoside poisoning could improve survival with favourable functional and neurological outcomes. Methods We searched the Medline, PubMed, EMBASE and Cochrane Library databases up to February 2022 for controlled trials, observational studies, and case reports. We reviewed studies if participants were exposed to a cardiac glycoside, had hemodynamic instability, and an intervention was attempted to reverse the toxicity. The effect of interventions on (1) survival with favourable functional and neurological outcomes and (2) correction of hemodynamic instability was assessed. Results Of the 2422 studies found, 73 were included for analysis, of which 58 were case reports or series, and 15 were observational cohorts. Most patients were intoxicated with medication (60 individual cases and 11 observational cohorts). Administration of digoxin immune-Fab fragments was associated with improved hemodynamic status and survival in medication patients. Administration of magnesium, cardioversion, and cardiac pacing was associated with favourable outcomes, while administration of atropine, antiarrhythmics, or calcium was not. Conclusion In patients with hemodynamic instability due to cardiac glycoside intoxication, digoxin immune-Fab fragments should be given, and magnesium administration, cardioversion, and cardiac pacing can reasonably be attempted.
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Affiliation(s)
- Jessie Beaulieu
- CHU de Québec Research Center CHU de Québec - Université Laval, Quebec City, QC, Canada
- Department of Medicine, Division of Nephrology, Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Maude St-Onge
- CHU de Québec Research Center CHU de Québec - Université Laval, Quebec City, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Centre antipoison du Québec, Quebec City, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
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Obara T, Yumoto T, Bunya N, Nojima T, Hiraoka T, Hongo T, Kosaki Y, Tsukahara K, Uehara T, Nakao A, Naito H. Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. Resusc Plus 2024; 19:100701. [PMID: 39040823 PMCID: PMC11260566 DOI: 10.1016/j.resplu.2024.100701] [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: 05/13/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024] Open
Abstract
Background The clinical impact of signs of life (SOLs) in traumatic cardiac arrest (TCA) remains to be elucidated. The aim of this study was to examine the association between SOLs and survival/neurological outcomes in TCA patients. Methods Retrospective data from the Japan Trauma Data Bank (2019-2021) was reviewed. TCA patients were assigned to one of two study groups based on the presence or absence of SOLs and compared. SOLs were defined as having at least one of following criteria: pulseless electrical activity >40 beats per minute, gasping, positive light reflex, or extremity/eye movement at hospital arrival. The primary outcome was survival at hospital discharge. The secondary outcome was favorable neurological status (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. Results A total of 1,981 patients (114 with SOLs and 1,867 without SOLs) were included. Characteristics of patients were as follows: age (median age 60.0 years old [interquartile range: 41-80] years vs. 55.4 [38-75] years), gender (male: 76/114 (66.7%) vs. 1,207/1,867 (65.0%), blunt trauma (90/111 [81.1%] vs. 1,559/1,844 [84.5%]), Injury Severity Score (29.2 [22-41] vs. 27.9 [20-34]). Patients with SOLs showed higher survival (10/114 (8.8%) vs. 25/1,867 (1.3%), OR 1.96 [CI 1.20-2.72]) and higher favorable neurological outcomes (4/110 (3.5%) vs. 6/1,865 (0.3%), OR 2.42 [CI 1.14-3.70]) compared with patients without SOLs. Conclusions TCA patients with SOLs at hospital arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOLs.
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Affiliation(s)
- Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Minami 1 Jo-nishi 17 chuo-ku, Sapporo 060-8556, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Tomohiro Hiraoka
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takenori Uehara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
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5
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Logan Ellis H, Al-Agil M, Kelly PA, Teo J, Sharpe C, Whyte MB. The burden of hyperkalaemia on hospital healthcare resources. Clin Exp Med 2024; 24:190. [PMID: 39136879 PMCID: PMC11322248 DOI: 10.1007/s10238-024-01452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 07/26/2024] [Indexed: 08/16/2024]
Abstract
Hyperkalaemia is associated with prolonged hospital admission and worse mortality. Hyperkalaemia may also necessitate clinical consults, therapies for hyperkalaemia and high-dependency bed utilisation. We evaluated the 'hidden' human and organisational resource utilisation for hyperkalaemia in hospitalised patients. This was a single-centre, observational cohort study (Jan 2017-Dec 2020) at a tertiary-care hospital. The CogStack system (data processing and analytics platform) was used to search unstructured and structured data from individual patient records. Association between potassium and death was modelled using cubic spline regression, adjusted for age, sex, and comorbidities. Cox proportional hazards estimated the hazard of death compared with normokalaemia (3.5-5.0 mmol/l). 129,172 patients had potassium measurements in the emergency department. Incidence of hyperkalaemia was 85.7 per 1000. There were 49,011 emergency admissions. Potassium > 6.5 mmol/L had 3.9-fold worse in-hospital mortality than normokalaemia. Chronic kidney disease was present in 21% with potassium 5-5.5 mmol/L and 54% with potassium > 6.5 mmol/L. For diabetes, it was 20% and 32%, respectively. Of those with potassium > 6.5 mmol/L, 29% had nephrology review, and 13% critical care review; in this group 22% transferred to renal wards and 8% to the critical care unit. Dialysis was used in 39% of those with peak potassium > 6.5 mmol/L. Admission hyperkalaemia and hypokalaemia were independently associated with reduced likelihood of hospital discharge. Hyperkalaemia is associated with greater in-hospital mortality and reduced likelihood of hospital discharge. It necessitated significant utilisation of nephrology and critical care consultations and greater likelihood of patient transfer to renal and critical care.
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Affiliation(s)
- Hugh Logan Ellis
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Mohammad Al-Agil
- Department of Basic and Clinical Neuroscience, School of Neuroscience, King's College London, London, UK
| | - Philip A Kelly
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - James Teo
- Department of Basic and Clinical Neuroscience, School of Neuroscience, King's College London, London, UK
| | - Claire Sharpe
- Renal Sciences, Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Martin B Whyte
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK.
- Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK.
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Liu S, Ling L, Fu Y, Zhang WC, Zhang YH, Li Q, Zeng L, Hu J, Luo Y, Liu WJ. Survival predictor in emergency resuscitative thoracotomy for blunt trauma patients: Insights from a Chinese trauma center. Chin J Traumatol 2024:S1008-1275(24)00082-8. [PMID: 39138046 DOI: 10.1016/j.cjtee.2024.07.009] [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] [Received: 03/14/2024] [Revised: 05/30/2024] [Accepted: 06/27/2024] [Indexed: 08/15/2024] Open
Abstract
PURPOSE Emergency resuscitative thoracotomy (ERT) is a final salvage procedure for critically injured trauma patients. Given its low success rate and ambiguous indications, its use in blunt trauma scenarios remains highly debated. Consequently, our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure. METHODS A retrospective case-control study was conducted for this research. Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis, with the endpoint outcome being in-hospital survival, divided into survival and non-survival groups. Inter-group comparisons were conducted using Chi-square and Fisher's exact tests, the Kruskal-Wallis test, Student's t-test, or the Mann-Whitney U test. Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival. Then, the efficacy of the predictors was assessed through sensitivity and specificity analysis. RESULTS A total of 33 patients were included in the study, with 4 survivors (12.12%). Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival, with an adjusted odds ratio of 33.4 (95% CI: 1.31 - 850, p = 0.034). Additionally, an analysis of sensitivity and specificity, targeting cardiac tamponade as an indicator for survivor identification, showed a sensitivity rate of 75.0% and a specificity rate of 96.6%. CONCLUSION The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations, suggesting that select individuals with blunt trauma can significantly benefit from the procedure. Notably, those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.
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Affiliation(s)
- Shan Liu
- Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Lin Ling
- The Second Affiliated Hospital, National Regional Key Cities and Sub-central Cities in Hunan Province Hengyang Academician and Expert International Academic Exchange High Tech University, Building A First-class Discipline for Trauma and Critical Care, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Yong Fu
- Department of Pediatric Orthopedics and Hand & Foot Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Wen-Chao Zhang
- Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Yong-Hu Zhang
- Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Qing Li
- Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Liang Zeng
- Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China
| | - Jun Hu
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China
| | - Yong Luo
- Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China.
| | - Wen-Jie Liu
- The Second Affiliated Hospital, National Regional Key Cities and Sub-central Cities in Hunan Province Hengyang Academician and Expert International Academic Exchange High Tech University, Building A First-class Discipline for Trauma and Critical Care, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China; Department of Anesthesiology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China.
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Stankovic I, Zivanic A, Vranic I, Neskovic AN. Correlations and discrepancies between cardiac ultrasound, clinical diagnosis and the autopsy findings in early deceased patients with suspected cardiovascular emergencies. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1353-1361. [PMID: 38652394 DOI: 10.1007/s10554-024-03107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Cardiac ultrasound (CUS), either focused cardiac ultrasound (FoCUS) or emergency echocardiography, is frequently used in cardiovascular (CV) emergencies. We assessed correlations and discrepancies between CUS, clinical diagnosis and the autopsy findings in early deceased patients with suspected CV emergencies. We retrospectively analysed clinical and autopsy data of 131 consecutive patients who died within 24 h of hospital admission. The type of CUS and its findings were analysed in relation to the clinical and autopsy diagnoses. CUS was performed in 58% of patients - FoCUS in 83%, emergency echocardiography in 12%, and both types of CUS in 5% of cases. CUS was performed more frequently in patients without a history of CV disease (64 vs. 40%, p = 0.08) and when the time between admission and death was longer (6 vs. 2 h, p = 0.021). In 7% of patients, CUS was inconclusive. In 10% of patients, the ante-mortem cause of death could not be determined, while discrepancies between the clinical and post-mortem diagnosis were found in 26% of cases. In the multivariate logistic regression model, only conclusive CUS [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.30-7.39, p = 0.044] and chest pain at presentation (OR 30.19, 95%CI 5.65 -161.22, p < 0.001) were independently associated with congruent clinical and autopsy diagnosis. In a tertiary university hospital, FoCUS was used more frequently than emergency echocardiography in critically ill patients with suspected cardiac emergencies. Chest pain at presentation and a conclusive CUS were associated with concordant clinical and autopsy diagnoses.
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Affiliation(s)
- Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Vukova 9, Belgrade, 11080, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Aleksandra Zivanic
- Department of Cardiology, Clinical Hospital Centre Zemun, Vukova 9, Belgrade, 11080, Serbia
| | - Ivona Vranic
- Department of Cardiology, Clinical Hospital Centre Zemun, Vukova 9, Belgrade, 11080, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Vukova 9, Belgrade, 11080, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Kirton LW, Cruz RS, Navarra L, Eathorne A, Cook J, Beasley R, Young PJ. Effect of automated titration of oxygen on time spent in a prescribed oxygen saturation range in adults in the ICU after cardiac surgery. CRIT CARE RESUSC 2024; 26:64-70. [PMID: 39072230 PMCID: PMC11282340 DOI: 10.1016/j.ccrj.2024.01.001] [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: 11/16/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 07/30/2024]
Abstract
Objective The objective of this study was to determine whether automated titration of the fraction of inspired oxygen (FiO2) increases the time spent with oxygen saturation (SpO2) within a predetermined target SpO2 range compared with manually adjusted high-flow oxygen therapy in postoperative cardiac surgical patients managed in the intensive care unit (ICU). Design Single-centre, open-label, randomised clinical trial. Setting Tertiary centre ICU. Participants Recently extubated adults following elective cardiac surgery who required supplemental oxygen. Interventions Automatically adjusted FiO2 (using an automated oxygen control system) compared with manual FiO2 titration, until cessation of oxygen therapy, ICU discharge, or 24 h (whichever was sooner). Main outcome measures The primary outcome was the proportion of time receiving oxygen therapy with the SpO2 in a SpO2 target range of 92-96 %. Results Among 65 participants, the percentage of time per patient spent in the target SpO2 range was a median of 97.7 % (interquartile range: 87.9-99.2 %) and 91.3 % (interquartile range: 77.1-96.1 %) in the automated (n = 28) and manual (n = 28) titration groups, respectively. The estimated effect of automated FiO2, compared to manual FiO2 titration, was to increase the percentage of time spent in the target range by a median of 4.8 percentage points (95 % confidence interval: 1.6 to 10.3 percentage points, p = 0.01). Conclusion In patients recently extubated after cardiac surgery, automated FiO2 titration significantly increased time spent in a target SpO2 range of 92-96 % compared to manual FiO2 titration.
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Affiliation(s)
- Louis W. Kirton
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Raulle Sol Cruz
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Te Whatu Ora, Capital and Coast, Wellington, New Zealand
| | - Leanlove Navarra
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Te Whatu Ora, Capital and Coast, Wellington, New Zealand
| | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Julie Cook
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University Wellington, Wellington, New Zealand
| | - Paul J. Young
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Te Whatu Ora, Capital and Coast, Wellington, New Zealand
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Morishita K, Unno T, Murakami T, Okada K, Matsunaga H, Asada K, Omori Y, Ishihara A, Kamoi Y, Tanaka T. A Case of Coronary Artery Perforation Caused by Manual Cardiopulmonary Resuscitation in the Catheterization Laboratory. Int Heart J 2024; 65:566-571. [PMID: 38749750 DOI: 10.1536/ihj.23-549] [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] [Indexed: 06/04/2024]
Abstract
Cardiopulmonary resuscitation (CPR) is essential for the survival of cardiac arrest patients, but it can cause severe traumatic complications. In the catheterization laboratory, various physical constraints complicate the appropriate performance of CPR. However, we are not aware of reports of CPR complications in this setting. Here, we report a case of coronary artery perforation (CAP) caused by manual CPR in the catheterization laboratory. The patient, a 68-year-old woman, initially underwent successful percutaneous coronary intervention (PCI) for unstable angina. Back in the ward, the patient experienced acute stent thrombosis, which resulted in cardiac arrest, and another PCI was performed under ongoing manual CPR. Although revascularization was successful, sudden CAP occurred, leading to cardiac tamponade. Despite extensive treatment efforts, the patient died 18 hours later.Initially, the compression site of CPR was on the midline of the sternum; however, the compression site shifted to the left, to just above the left anterior descending artery, by the time that CAP was detected via angiography. This corresponded to the area where rib fractures were observed upon computed tomography, suggesting the possibility of traumatic CAP due to manual CPR. The physical constraints in the catheterization laboratory can lead to an inappropriate CPR technique and severe traumatic complications.
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Affiliation(s)
- Kei Morishita
- Department of Cardiology, Showa General Hospital
- Department of Cardiology, The University of Tokyo Hospital
| | | | | | | | | | - Kazuo Asada
- Department of Cardiology, Showa General Hospital
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Chander S, Parkash O, Luhana S, Lohana AC, Sadarat F, Sapna F, Raja F, Rahaman Z, Mohammed YN, Shiwlani S, Kiran N, Wang HY, Tan S, Kumari R. Mortality, morbidity & clinical outcome with different types of vasopressors in out of hospital cardiac arrest patients- a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:283. [PMID: 38816786 PMCID: PMC11137957 DOI: 10.1186/s12872-024-03962-4] [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: 12/14/2023] [Accepted: 05/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND & OBJECTIVE Despite their continued use, the effectiveness and safety of vasopressors in post-cardiac arrest patients remain controversial. This study examined the efficacy of various vasopressors in cardiac arrest patients in terms of clinical, morbidity, and mortality outcomes. METHODS A comprehensive literature search was performed using online databases (MeSH terms: MEDLINE (Ovid), CENTRAL (Cochrane Library), Embase (Ovid), CINAHL, Scopus, and Google Scholar) from 1997 to 2023 for relevant English language studies. The primary outcomes of interest for this study included short-term survival leading to death, return of spontaneous circulation (ROSC), survival to hospital discharge, neurological outcomes, survival to hospital admission, myocardial infarction, and incidence of arrhythmias. RESULTS In this meta-analysis, 26 studies, including 16 RCTs and ten non-RCTs, were evaluated. The focus was on the efficacy of epinephrine, vasopressin, methylprednisolone, dopamine, and their combinations in medical emergencies. Epinephrine treatment was associated with better odds of survival to hospital discharge (OR = 1.52, 95%CI [1.20, 1.94]; p < 0.001) and achieving ROSC (OR = 3.60, 95% CI [3.45, 3.76], P < 0.00001)) over placebo but not in other outcomes of interest such as short-term survival/ death at 28-30 days, survival to hospital admission, or neurological function. In addition, our analysis indicates non-superiority of vasopressin or epinephrine vasopressin-plus-epinephrine therapy over epinephrine monotherapy except for survival to hospital admission where the combinatorial therapy was associated with better outcome (0.76, 95%CI [0.64, 0.92]; p = 0.004). Similarly, we noted the non-superiority of vasopressin-plus-methylprednisolone versus placebo. Finally, while higher odds of survival to hospital discharge (OR = 3.35, 95%CI [1.81, 6.2]; p < 0.001) and ROSC (OR = 2.87, 95%CI [1.97, 4.19]; p < 0.001) favoring placebo over VSE therapy were observed, the risk of lethal arrhythmia was not statistically significant. There was insufficient literature to assess the effects of dopamine versus other treatment modalities meta-analytically. CONCLUSION This meta-analysis indicated that only epinephrine yielded superior outcomes among vasopressors than placebo, albeit limited to survival to hospital discharge and ROSC. Additionally, we demonstrate the non-superiority of vasopressin over epinephrine, although vasopressin could not be compared to placebo due to the paucity of data. The addition of vasopressin to epinephrine treatment only improved survival to hospital admission.
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Affiliation(s)
- Subhash Chander
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Om Parkash
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Sindhu Luhana
- Department of Medicine, AGA khan University Hospital, Karachi, Pakistan
| | - Abhi Chand Lohana
- Department of Medicine, Western Michigan University, Kalamazoo, WV, USA
| | - Fnu Sadarat
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Fnu Sapna
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - Fnu Raja
- Department of Pathology, MetroHealth Hospital, Cleveland, OH, USA
| | - Zubair Rahaman
- Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | | | - Sheena Shiwlani
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nfn Kiran
- Department of Pathology, Northwell Health Hospital, New York, NY, USA
| | - Hong Yu Wang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sam Tan
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roopa Kumari
- Department of Pathology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
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11
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Ellauzi R, Erdem S, Salam MF, Kumar A, Aggarwal V, Koenig G, Aronow HD, Basir MB. Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism. J Clin Med 2024; 13:3161. [PMID: 38892871 PMCID: PMC11172824 DOI: 10.3390/jcm13113161] [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: 03/18/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible therapeutic benefits in patients who are unresponsive to standard therapeutic options. Moreover, attention is given to device selection criteria, weaning protocols, and complication mitigation strategies. Finally, we underscore the necessity for more comprehensive studies to corroborate the benefits and safety of MCS devices in PE management.
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Affiliation(s)
- Rama Ellauzi
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Saliha Erdem
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI 48202, USA;
| | - Mohammad Fahad Salam
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48502, USA;
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, USA;
| | - Vikas Aggarwal
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Gerald Koenig
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Herbert D. Aronow
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Mir Babar Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
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Strobel RJ, Money DT, Young AM, Wisniewski AM, Norman AV, Ahmad RM, Kaplan EF, Joseph M, Quader M, Mazzeffi M, Yarboro LT, Teman NR. Extracorporeal Life Support Organization Center of Excellence recognition is associated with improved failure to rescue after cardiac arrest. J Thorac Cardiovasc Surg 2024; 167:1866-1877.e1. [PMID: 37156364 PMCID: PMC10626046 DOI: 10.1016/j.jtcvs.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The influence of Extracorporeal Life Support Organization (ELSO) center of excellence (CoE) recognition on failure to rescue after cardiac surgery is unknown. We hypothesized that ELSO CoE would be associated with improved failure to rescue. METHODS Patients undergoing a Society of Thoracic Surgeons index operation in a regional collaborative (2011-2021) were included. Patients were stratified by whether or not their operation was performed at an ELSO CoE. Hierarchical logistic regression analyzed the association between ELSO CoE recognition and failure to rescue. RESULTS A total of 43,641 patients were included across 17 centers. In total, 807 developed cardiac arrest with 444 (55%) experiencing failure to rescue after cardiac arrest. Three centers received ELSO CoE recognition, and accounted for 4238 patients (9.71%). Before adjustment, operative mortality was equivalent between ELSO CoE and non-ELSO CoE centers (2.08% vs 2.36%; P = .25), as was the rate of any complication (34.5% vs 33.8%; P = .35) and cardiac arrest (1.49% vs 1.89%; P = .07). After adjustment, patients undergoing surgery at an ELSO CoE facility were observed to have 44% decreased odds of failure to rescue after cardiac arrest, relative to patients at non-ELSO CoE facility (odds ratio, 0.56; 95% CI, 0.316-0.993; P = .047). CONCLUSIONS ELSO CoE status is associated with improved failure to rescue following cardiac arrest for patients undergoing cardiac surgery. These findings highlight the important role that comprehensive quality programs serve in improving perioperative outcomes in cardiac surgery.
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Affiliation(s)
- Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Dustin T Money
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Andrew M Young
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Alex M Wisniewski
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Anthony V Norman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Raza M Ahmad
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Emily F Kaplan
- School of Medicine, University of Virginia, Charlottesville, Va
| | - Mark Joseph
- Carilion Clinic Cardiothoracic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Va
| | - Mohammed Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Va
| | - Michael Mazzeffi
- Department of Anesthesiology, University of Virginia, Charlottesville, Va
| | - Leora T Yarboro
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
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13
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Roach SN, Fletcher ML, Sarangarm P. A Retrospective Analysis of Intravenous Insulin versus Insulin and Nebulized Albuterol for the Treatment of Hyperkalemia in the Emergency Department. J Clin Pharmacol 2024; 64:619-625. [PMID: 38100157 DOI: 10.1002/jcph.2396] [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: 09/22/2023] [Accepted: 12/10/2023] [Indexed: 01/10/2024]
Abstract
There is limited literature evaluating the use of nebulized albuterol in the management of hyperkalemia. The objective was to evaluate the efficacy of insulin alone compared with the addition of nebulized albuterol for the treatment of hyperkalemia. This is a retrospective, single-center evaluation of adult patients with hyperkalemia attending the Emergency Department of a large urban academic medical center. Consecutive patients with a potassium level of >5 mmol/L were included. Patients without a repeat potassium level within 4 hours of medication administration, those receiving hemodialysis before a repeat serum potassium, or those that had a hemolyzed blood sample were excluded. The primary outcome was the change in potassium level within 4 hours in patients who received insulin monotherapy versus patients who received insulin and albuterol. The secondary outcomes included hospital length of stay, intensive care unit (ICU) admission, and mortality. Out of the 204 patients, 141 received insulin, whereas 63 received insulin and nebulized albuterol. There was no difference in the change in potassium level between the insulin and the insulin and nebulized albuterol groups (0.85 ± 0.6 vs 0.96 ± 0.78 mmol/L; P = .36). There was no difference in median hospital length of stay (8.6 days, IQR 13.2 days, vs 5.6 days, IQR 8.2 days; P = .09), ICU admission (31.9% vs 38.1%; P = .39), and all-cause mortality (14.9% vs 17.5%; P = .64). In this retrospective analysis, the addition of albuterol to insulin for the treatment of hyperkalemia did not result in a greater change in potassium level within 4 hours of therapy.
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Affiliation(s)
- Sara N Roach
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
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14
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Rouleau SG, Casey SD, Kabrhel C, Vinson DR, Long B. Management of high-risk pulmonary embolism in the emergency department: A narrative review. Am J Emerg Med 2024; 79:1-11. [PMID: 38330877 DOI: 10.1016/j.ajem.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND High-risk pulmonary embolism (PE) is a complex, life-threatening condition, and emergency clinicians must be ready to resuscitate and rapidly pursue primary reperfusion therapy. The first-line reperfusion therapy for patients with high-risk PE is systemic thrombolytics (ST). Despite consensus guidelines, only a fraction of eligible patients receive ST for high-risk PE. OBJECTIVE This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations. DISCUSSION High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions. CONCLUSIONS Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies.
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Affiliation(s)
- Samuel G Rouleau
- Department of Emergency Medicine, UC Davis Health, University of California, Davis, Sacramento, CA, United States of America.
| | - Scott D Casey
- Kaiser Permanente Northern California Division of Research, The Permanente Medical Group, Oakland, CA, United States of America; Department of Emergency Medicine, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, United States of America.
| | - Christopher Kabrhel
- Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - David R Vinson
- Kaiser Permanente Northern California Division of Research, The Permanente Medical Group, Oakland, CA, United States of America; Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, CA, United States of America.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States of America.
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15
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Eisendle F, Rauch S, Wallner B, Brugger H, Strapazzon G. Prevalence of airway patency and air pocket in critically buried avalanche victims - a scoping review. Scand J Trauma Resusc Emerg Med 2024; 32:34. [PMID: 38654361 PMCID: PMC11040957 DOI: 10.1186/s13049-024-01205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Survival of critically buried avalanche victims is directly dependent on the patency of the airway and the victims' ability to breathe. While guidelines and avalanche research have consistently emphasized on the importance of airway patency, there is a notable lack of evidence regarding its prevalence. OBJECTIVE The aim of this review is to provide insight into the prevalence of airway patency and air pocket in critically buried avalanche victims. METHODS A scoping review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline extension for scoping reviews. MEDLINE and Cochrane databases, as well as additional manual searching was performed to identify literature reporting data on airway patency and the presence of an air pocket in critically buried avalanche victims. After eliminating duplicates, we screened abstracts and main texts to identify eligible studies. RESULTS Of 4,109 studies identified 154 were eligible for further screening. Twenty-four publications and three additional data sources with a total number of 566 cases were included in this review. The proportion of short-term (< 35 min) to long-term burial (≥ 35 min) in the analysed studies was 19% and 66%, respectively. The burial duration remained unknown in 12% of cases. The prevalence of airway patency in critically buried avalanche victims was 41% while that of airway obstruction was 12%, with an overall rate of reporting as low as 50%. An air pocket was present in 19% of cases, absent in 46% and unknown in 35% of the cases. CONCLUSION The present study found that in critically buried avalanche victims patent airways were more than three times more prevalent than obstructed, with the airway status reported only in half of the cases. This high rate of airway patency supports the ongoing development and the effectiveness of avalanche rescue systems which oppose asphyxiation in critically buried avalanche victims. Further effort should be done to improve the documentation of airway patency and the presence of an air pocket in avalanche victims and to identify factors affecting the rate of airway obstruction.
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Affiliation(s)
- Frederik Eisendle
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- Department of Anaesthesia and Intensive Care Medicine, Hospital of Merano, Merano, Italy
| | - Bernd Wallner
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy.
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
- SIMeM Italian Society of Mountain Medicine, Padova, Italy.
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16
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Gentile G, Hossain J, Carluccio E, Reboldi G. Managing hyperkalemia in patients with heart failure on guideline-directed medical therapy: challenges and opportunities. Intern Emerg Med 2024; 19:599-603. [PMID: 38448689 DOI: 10.1007/s11739-024-03571-1] [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: 12/17/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
Heart failure is a chronic and invalidating syndrome that affects tens of millions of people worldwide with significant socio-economic ramifications for the health care systems. Significant progress in the understanding of the pathophysiology of heart failure has allowed the gradual introduction of several drug classes for the management of such patients. Beta-blockers, mineralocorticoid receptor antagonists, angiotensin receptor neprilysin inhibitors, and sodium-glucose-cotransporter 2 inhibitors are all considered pillars of the guideline-directed medical therapy for heart failure. Despite remarkable improvements in the morbidity and mortality of heart failure, however, many patients still develop clinically significant hyperkalemia during combined treatment with those four pharmacological pillars. The consequence is often a down-titration or discontinuation of one or more crucial drugs, which in turns leads to a considerable increase in the risk of cardiovascular events, dialysis, and all-cause mortality. This paper will explore novel approaches for the management of hyperkalemia in heart failure, including closer monitoring of potassium levels, early review of drugs that might increase the risk of hyperkalemia, and pharmacological treatment of hyperkalemia, with a special emphasis on sodium-glucose-cotransporter 2 inhibitors and potassium-binding agents, including patiromer and sodium zirconium cyclosilicate.
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Affiliation(s)
- Giorgio Gentile
- Department of Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jahid Hossain
- Department of Nephrology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Erberto Carluccio
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi, 1, 06132, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi, 1, 06132, Perugia, Italy.
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Podsiadło P, Brožek T, Balik M, Nowak E, Mendrala K, Hymczak H, Dąbrowski W, Miazgowski B, Rutkiewicz A, Burysz M, Witt-Majchrzak A, Jędrzejczak T, Podsiadło R, Darocha T. Predictors of cardiac arrest in severe accidental hypothermia. Am J Emerg Med 2024; 78:145-150. [PMID: 38281374 DOI: 10.1016/j.ajem.2024.01.031] [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: 11/12/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
STUDY OBJECTIVE To indicate predictors of witnessed hypothermic cardiac arrest. METHODS We conducted a retrospective analysis of 182 patients with severe accidental hypothermia (i.e., with core body temperature of ≤28 °C) who presented with preserved spontaneous circulation at first contact with medical services. We divided the study population into two groups: patients who suffered hypothermic cardiac arrest (HCA) at any time between encounter with medical service and restoration of normothermia, and those who did not sustain HCA. The analyzed outcome was the occurrence of cardiac arrest prior to achieving normothermia. Hemodynamic and biochemical parameters were analyzed with regard to their association with the outcome. RESULTS Fifty-two (29%) patients suffered HCA. In a univariable analysis, four variables were significantly associated with the outcome, namely heart rate (p < 0.001), systolic blood pressure (p = 0.03), ventricular arrhythmia (p = 0.001), and arterial oxygen partial pressure (p = 0.002). In the multivariable logistic regression the best model predicting HCA included heart rate, PaO2, and Base Excess (AUROC = 0.78). In prehospital settings, when blood gas analysis is not available, other multivariable model including heart rate and occurrence of ventricular arrhythmia (AUROC = 0.74) can be used. In this study population, threshold values of heart rate of 43/min, temperature-corrected PaO2 of 72 mmHg, and uncorrected PaO2 of 109 mmHg, presented satisfactory sensitivity and specificity for HCA prediction. CONCLUSIONS In patients with severe accidental hypothermia, the occurrence of HCA is associated with a lower heart rate, hypoxemia, ventricular arrhythmia, lower BE, and lower blood pressure. These parameters can be helpful in the early selection of high-risk patients and their allocation to extracorporeal rewarming facilities.
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Affiliation(s)
- Paweł Podsiadło
- Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland.
| | - Tomáš Brožek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ewelina Nowak
- Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Hubert Hymczak
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Wojciech Dąbrowski
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Bartosz Miazgowski
- Emergency Department, University Hospital, Pomeranian Medical University, Szczecin, Poland
| | | | - Marian Burysz
- Departament of Cardiac Surgery, Dr. Władysław Biegański Regional Specialist Hospital, Grudziądz, Poland
| | - Anna Witt-Majchrzak
- Department of Cardiac Surgery Provincial Specialist Hospital, Olsztyn, Poland
| | - Tomasz Jędrzejczak
- Department of Cardiosurgery, Pomeranian Medical University in Szczecin, Poland
| | - Rafał Podsiadło
- Department of Anaesthesiology and Intensive Care, University Hospital, Wrocław, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
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Aranda-García S, San Román-Mata S, Otero-Agra M, Rodríguez-Núñez A, Fernández-Méndez M, Navarro-Patón R, Barcala-Furelos R. Is the Over-the-Head Technique an Alternative for Infant CPR Performed by a Single Rescuer? A Randomized Simulation Study with Lifeguards. Pediatr Rep 2024; 16:100-109. [PMID: 38390998 PMCID: PMC10885125 DOI: 10.3390/pediatric16010010] [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] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Objective: The objective was to evaluate the quality of cardiopulmonary resuscitation (CPR, chest compressions and ventilations) when performed by a lone first responder on an infant victim via the over-the-head technique (OTH) with bag-mask ventilation in comparison with the standard lateral technique (LAT) position. (2) Methods: A randomized simulation crossover study in a baby manikin was conducted. A total of 28 first responders performed each of the techniques in two separate CPR tests (15:2 chest compressions:ventilations ratio), each lasting 5 min with a 15 min resting period. Quality CPR parameters were assessed using an app connected to the manikin. Those variables were related to chest compressions (CC: depth, rate, and correct CC point) and ventilation (number of effective ventilations). Additional variables included perceptions of the ease of execution of CPR. (3) Results: The median global CPR quality (integrated CC + V) was 82% with OTH and 79% with LAT (p = 0.94), whilst the CC quality was 88% with OTH and 80% with LAT (p = 0.67), and ventilation quality was 85% with OTH and 85% with LAT (p = 0.98). Correct chest release was significantly better with OTH (OTH: 92% vs. LAT: 62%, p < 0.001). There were no statistically significant differences in the remaining variables. Ease of execution perceptions favored the use of LAT over OTH. (4) Conclusions: Chest compressions and ventilations can be performed with similar quality in an infant manikin by lifeguards both with the standard recommended position (LAT) and the alternative OTH. This option could give some advantages in terms of optimal chest release between compressions. Our results should encourage the assessment of OTH in some selected cases and situations as when a lone rescuer is present and/or there are physical conditions that could impede the lateral rescue position.
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Affiliation(s)
- Silvia Aranda-García
- GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), 08038 Barcelona, Spain
- CLINURSID Research Group, Faculty of Nursing, University of Santiago de Compostela, 15782 A Coruña, Spain
| | - Silvia San Román-Mata
- REMOSS Research Group, Faculty of Education and Sports Sciences, University of Vigo, 36005 Pontevedra, Spain
- Nursing Department, University of Granada, 18071 Granada, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, Faculty of Education and Sports Sciences, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing of Pontevedra, University of Vigo, 36001 Pontevedra, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Faculty of Nursing, University of Santiago de Compostela, 15782 A Coruña, Spain
- Research Group in Simulation, Life Support and Intensive Care (SICRUS), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, 15706 A Coruña, Spain
- Critical Pediatric Section, Pediatric Intermediate and Palliative Care, Hospital Clínico Universitario de Santiago, Santiago de Compostela, 15706 A Coruña, Spain
- RICORS of Primary Care Interventions to Prevent Maternal and Chronic Childhood Illnesses of Perinatal and Developmental Origin, RD21/0012/0025, Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - María Fernández-Méndez
- CLINURSID Research Group, Faculty of Nursing, University of Santiago de Compostela, 15782 A Coruña, Spain
- REMOSS Research Group, Faculty of Education and Sports Sciences, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing of Pontevedra, University of Vigo, 36001 Pontevedra, Spain
| | - Rubén Navarro-Patón
- Faculty of Teacher Training, University of Santiago de Compostela, 27001 Lugo, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sports Sciences, University of Vigo, 36005 Pontevedra, Spain
- Research Group in Simulation, Life Support and Intensive Care (SICRUS), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, 15706 A Coruña, Spain
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Krammel M, Frimmel N, Hamp T, Grassmann D, Widhalm H, Verdonck P, Reisinger C, Sulzgruber P, Schnaubelt S. Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 - 2017. Injury 2024; 55:110971. [PMID: 37544864 DOI: 10.1016/j.injury.2023.110971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Trauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe - with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. METHODS For this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score ≥ IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. RESULTS We included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. CONCLUSIONS Severe cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. TRIAL REGISTRATION Retrospective analysis without intervention.
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Affiliation(s)
| | - Nikolaus Frimmel
- Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Hamp
- Emergency Medical Service Vienna, Vienna, Austria; Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Harald Widhalm
- Dept. of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philip Verdonck
- Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
| | | | - Patrick Sulzgruber
- Division of Cardiology, Dept. of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Sebastian Schnaubelt
- Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium; Dept. of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
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20
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Weant KA, Gregory H. Acute Hyperkalemia Management in the Emergency Department. Adv Emerg Nurs J 2024; 46:12-24. [PMID: 38285416 DOI: 10.1097/tme.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Acute hyperkalemia is characterized by high concentrations of potassium in the blood that can potentially lead to life-threatening arrhythmias that require emergent treatment. Therapy involves the utilization of a constellation of different agents, all targeting different goals of care. The first, and most important step in the treatment of severe hyperkalemia with electrocardiographic (ECG) changes, is to stabilize the myocardium with calcium in order to resolve or mitigate the development of arrythmias. Next, it is vital to target the underlying etiology of any ECG changes by redistributing potassium from the extracellular space with the use of intravenous regular insulin and inhaled beta-2 agonists. Finally, the focus should shift to the elimination of excess potassium from the body through the use of intravenous furosemide, oral potassium-binding agents, or renal replacement therapy. Multiple nuances and controversies exist with these therapies, and it is important to have a robust understanding of the underlying support and recommendations for each of these agents to ensure optimal efficacy and minimize the potential for adverse effects and medication errors.
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Affiliation(s)
- Kyle A Weant
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia (Dr Weant); and Department of Pharmacy, University of North Carolina Health, Chapel Hill (Dr Gregory)
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21
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Peixoto-Pino L, Barcala-Furelos R, Paz-García B, Varela-Casal C, Lorenzo-Martínez M, Gómez-Silva A, Rico-Díaz J, Rodríguez-Núñez A. The "DrownSafe" Project: Assessing the Feasibility of a Puppet Show in Teaching Drowning Prevention to Children and Parents. CHILDREN (BASEL, SWITZERLAND) 2023; 11:19. [PMID: 38255332 PMCID: PMC10814459 DOI: 10.3390/children11010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Drowning remains a prominent global pediatric health concern, necessitating preventive measures such as educational initiatives for children and caregivers. In this study, we aimed to assess the feasibility and educational effectiveness of an interactive puppet show centered on teaching water safety to children and parents. A 30 min original theater performance, featuring two actors and three puppets (a girl, a crab, and a lifeguard), was conducted. Subsequently, 185 children (aged 4 to 8) and their 160 parents (134 mothers and 26 fathers) participated in this quasi-experimental study. Pre- and post-show tests were administered to evaluate knowledge and behaviors regarding aquatic environments. Prior to the puppet show, 78% of the children exhibited basic aquatic competency. Only 33% considered swimming alone risky. Following the intervention, 81.6% of the children changed their perception of the risks of solo beach activities, showing improved knowledge regarding contacting an emergency number (from 63.2% to 98.9%, p < 0.001). The intervention increased parents' intention to visit lifeguard-patrolled beaches and improved their CPR knowledge with regard to drowning victims by 58.8%. In conclusion, a drowning prevention puppet show positively impacted children and parents, potentially enhancing safety behaviors during water-related leisure activities, warranting its consideration part of comprehensive drowning prevention strategies.
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Affiliation(s)
- Lucía Peixoto-Pino
- Facultade de Ciencias da Educación, Universidade de Santiago de Compostela, 15706 A Coruña, Spain; (L.P.-P.); (J.R.-D.)
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15706 A Coruña, Spain;
| | - Roberto Barcala-Furelos
- REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36005 Pontevedra, Spain; (B.P.-G.); (C.V.-C.); (M.L.-M.); (A.G.-S.)
| | - Begoña Paz-García
- REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36005 Pontevedra, Spain; (B.P.-G.); (C.V.-C.); (M.L.-M.); (A.G.-S.)
| | - Cristina Varela-Casal
- REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36005 Pontevedra, Spain; (B.P.-G.); (C.V.-C.); (M.L.-M.); (A.G.-S.)
| | - Miguel Lorenzo-Martínez
- REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36005 Pontevedra, Spain; (B.P.-G.); (C.V.-C.); (M.L.-M.); (A.G.-S.)
| | - Adrián Gómez-Silva
- REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Universidade de Vigo, 36005 Pontevedra, Spain; (B.P.-G.); (C.V.-C.); (M.L.-M.); (A.G.-S.)
| | - Javier Rico-Díaz
- Facultade de Ciencias da Educación, Universidade de Santiago de Compostela, 15706 A Coruña, Spain; (L.P.-P.); (J.R.-D.)
- ESCULCA Knowledge and Educational Action Research Group, Universidade de Santiago de Compostela, 15706 A Coruña, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15706 A Coruña, Spain;
- Faculty of Nursing, Universidade de Santiago de Compostela, 15782 A Coruña, Spain
- Paediatric Critical, Intermediate and Palliative Care Section, Hospital Clínico Universitario de Santiago de Compostela, 15706 A Coruña, Spain
- Collaborative Research Network Orientated to Health Results (RICORS): Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela (CHUS), 15706 A Coruña, Spain
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22
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Khosla A, Zhao Y, Mojibian H, Pollak J, Singh I. High-Risk Pulmonary Embolism: Management for the Intensivist. J Intensive Care Med 2023; 38:1087-1098. [PMID: 37455352 DOI: 10.1177/08850666231188290] [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] [Indexed: 07/18/2023]
Abstract
High-risk pulmonary embolism (PE) also known as massive PE carries a high rate of morbidity and mortality. The incidence of high-risk PE continues to increase, yet the outcomes of high-risk PE continue to remain poor. Patients with high-risk PE are often critically ill, with complex underlying physiology, and treatment for the high-risk PE patient almost always requires care and management from an intensivist. Treatment options for high-risk PE continue to evolve rapidly with multiple options for definitive reperfusion therapy and supportive care. A thorough understanding of the physiology, risk stratification, treatment, and support options for the high-risk PE patient is necessary for all intensivists in order to improve outcomes. This article aims to provide a review from an intensivist's perspective highlighting the physiological consequences, risk stratification, and treatment options for these patients as well as providing a proposed algorithm to the risk stratification and acute management of high-risk PE.
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Affiliation(s)
- Akhil Khosla
- Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Yiyu Zhao
- Department of Anesthesia, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Jeffrey Pollak
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Inderjit Singh
- Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
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23
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Strobel RJ, Kaplan EF, Young AM, Wisniewski AM, Ising MS, Chaudry B, Speir A, Quader M, Mehaffey JH, Beller JP, Teman NR. The Society of Thoracic Surgeons Definition of Failure to Rescue Should Consider Including Cardiac Arrest. Ann Thorac Surg 2023; 116:1301-1308. [PMID: 37271448 PMCID: PMC10693650 DOI: 10.1016/j.athoracsur.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/28/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Failure to rescue (FTR) is a new quality measure in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. The STS defines FTR as death after permanent stroke, renal failure, reoperation, or prolonged ventilation. Our objective was to assess whether cardiac arrest should be included in this definition. METHODS Patients undergoing an STS index operation in a regional collaborative (2011-2021) were included. The performance of the STS definition of FTR was compared with a definition that included the STS complications plus cardiac arrest (STS+). Centers were grouped into FTR rate terciles using the STS and STS+ definitions of FTR, and changes in their relative performance rating were assessed. RESULTS A total of 43,641 patients were included across 17 centers. Cardiac arrest was the most lethal complication: 55.0% of patients who experienced cardiac arrest died. FTR after any complication (13 total) occurred among 884 patients. The STS definition of FTR accounted for 83% (735 of 884) of all FTR. The addition of cardiac arrest to the STS definition significantly increased the proportion of overall FTR accounted for (92.2% [815 of 884]; P < .001). Choice of FTR definition led to substantial differences in center-level relative performance rating by FTR rate. CONCLUSIONS Mortality after cardiac arrest is not completely captured by the STS definition of FTR and represents an important source of potentially preventable death after cardiac surgery. Future quality improvement efforts using the STS definition of FTR should account for this.
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Affiliation(s)
- Raymond J Strobel
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Emily F Kaplan
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Andrew M Young
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex M Wisniewski
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Mickey S Ising
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Bakhtiar Chaudry
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan Speir
- Cardiac Surgery, Inova Fairfax Hospital, Fairfax, Virginia
| | - Mohammed Quader
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - J Hunter Mehaffey
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Jared P Beller
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Cardiac Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Seyfrydova M, Rokyta R, Rajdl D, Huml M. Arrhythmias and laboratory abnormalities after an electrical accident: a single-center, retrospective study of 333 cases. Clin Res Cardiol 2023; 112:1835-1847. [PMID: 37526697 DOI: 10.1007/s00392-023-02274-5] [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: 01/17/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Even though electrical injuries are common in the emergency room, guidelines, consensus, and general recommendations for the management of these patients do not exist in Europe. Documented cases of delayed arrhythmias are rare and their connection with electrical injury has not been fully confirmed. We also use cardio-specific markers for the risk stratification of myocardial injury, but there is no significant study referring to their utility in this clinical situation. These reasons led us to retrospectively analyze all cases of electrical injuries over 23 years to determine the prevalence of cardiac arrhythmias (mainly malignant arrhythmias and delayed arrhythmias). METHODS We retrospectively searched all patients admitted to the University Hospital in Pilsen, CZ, with a diagnosis of electric injury (ICD diagnostic code T754) from 1997 to 2020. The hospital´s information system was used to research the injury; data were drawn from patient medical records. RESULTS We identified 333 cases of electrical injury in our hospital. Men accounted for about two-thirds, and women one-third. Children accounted for about one-third of cases. Most were low-voltage injuries (< 1000 V, 91.6%). All participants had an initial ECG, and 77.5% of patients had continuous ECG monitoring, usually lasting 24 h. Cardiac arrhythmias were noticed in 39 patients (11.7%). The most frequent arrhythmias were: ventricular fibrillation, sinus tachycardia, bradycardia and arrhythmia, atrial fibrillation, and supraventricular tachycardia. The ECG showed cardiac conduction abnormalities in 28 patients (8.1%), and ten patients (3%) had supraventricular or ventricular extrasystoles. In ten cases (3%), we found changes in ST segments and T waves on the initial ECG. Thirty-one patients (9.3%) suffered a loss of consciousness and 50 patients (15.02%) reported paresthesia. The most frequent ion disbalances were hypokalemia (18%) and hypocalcemia (3.3%). Patients with an ion disbalance had significantly more arrhythmias and newly diagnosed cardiac conduction abnormalities. Troponin levels (cTnI or hs-cTnT) were measured in 258 cases (77.48%) and found to be elevated above the 99th percentile in 19 cases (5.7%). Almost one-third of patients had burns of various degrees of seriousness, and 41 patients (12.3%) had concomitant traumatic injuries. Eleven patients underwent pre-hospital resuscitation, three died in the hospital, and another died as result of intracranial hemorrhage. CONCLUSION All malignant arrhythmias occurred immediately after the electrical injury, delayed life-threatening arrhythmias were not observed, and no predictive factors of malignant arrhythmias were found. While elevations of cardiac troponins were observed sporadically, they did not appear helpful for risk stratification. In patients with arrhythmias, ion disbalance may be more critical. We concluded that asymptomatic, uninjured adult and pediatric patients with normal initial ECG findings do not need continuous ECG monitoring and may be discharged home. Recommendations for high-risk patients and patients with mild ECG abnormalities at admission are less obvious.
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Affiliation(s)
- Miroslava Seyfrydova
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic.
| | - Richard Rokyta
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
| | - Daniel Rajdl
- Institute of Clinical Biochemistry and Laboratory Diagnostics, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Huml
- Department of Pediatrics, University Hospital and Faculty of Medicine Pilsen, Charles University, Pilsen, Czech Republic
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25
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Niemann M, Graef F, Hahn F, Schilling EC, Maleitzke T, Tsitsilonis S, Stöckle U, Märdian S. Emergency thoracotomies in traumatic cardiac arrests following blunt trauma - experiences from a German level I trauma center. Eur J Trauma Emerg Surg 2023; 49:2177-2185. [PMID: 37270467 PMCID: PMC10519862 DOI: 10.1007/s00068-023-02289-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Resuscitative thoracotomies (RT) are the last resort to reduce mortality in patients suffering severe trauma. In recent years, indications for RT have been extended from penetrating to blunt trauma. However, discussions on efficacy are still ongoing, as data on this rarely performed procedure are often scarce. Therefore, this study analyzed RT approaches, intraoperative findings, and clinical outcome measures following RT in patients with cardiac arrest following blunt trauma. METHODS All patients admitted to our level I trauma center's emergency room (ER) who underwent RT between 2010 and 2021 were retrospectively analyzed. Retrospective chart reviews were performed for clinical data, laboratory values, injuries observed during RT, and surgical procedures. Additionally, autopsy protocols were assessed to describe injury patterns accurately. RESULTS Fifteen patients were included in this study with a median ISS of 57 (IQR 41-75). The 24-h survival rate was 20%, and the total survival rate was 7%. Three approaches were used to expose the thorax: Anterolateral thoracotomy, clamshell thoracotomy, and sternotomy. A wide variety of injuries were detected, which required complex surgical interventions. These included aortic cross-clamping, myocardial suture repairs, and pulmonary lobe resections. CONCLUSION Blunt trauma often results in severe injuries in various body regions. Therefore, potential injuries and corresponding surgical interventions must be known when performing RT. However, the chances of survival following RT in traumatic cardiac arrest cases following blunt trauma are small.
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Affiliation(s)
- Marcel Niemann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Frank Graef
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Fabienne Hahn
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Elisa Celine Schilling
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tazio Maleitzke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Serafeim Tsitsilonis
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ulrich Stöckle
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sven Märdian
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353, Berlin, Germany
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Hall N, Métrailler-Mermoud J, Cools E, Fehlmann C, Carron PN, Rousson V, Grabherr S, Schrag B, Kirsch M, Frochaux V, Pasquier M. Hypothermic cardiac arrest patients admitted to hospital who were not rewarmed with extracorporeal life support: A retrospective study. Resusc Plus 2023; 15:100443. [PMID: 37638095 PMCID: PMC10448201 DOI: 10.1016/j.resplu.2023.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Aims Our goal was to study hypothermic cardiac arrest (CA) patients who were not rewarmed by Extracorporeal Life Support (ECLS) but were admitted to a hospital equipped for it. The focus was on whether the decisions of non-rewarming, meaning termination of resuscitation, were compliant with international guidelines based on serum potassium at hospital admission. Methods We retrospectively included all hypothermic CA who were not rewarmed, from three Swiss centers between 1st January 2000 and 2nd May 2021. Data were extracted from medical charts and assembled into two groups for analysis according to serum potassium. We identified the criteria used to terminate resuscitation. We also retrospectively calculated the HOPE score, a multivariable tool predicting the survival probability in hypothermic CA undergoing ECLS rewarming. Results Thirty-eight victims were included in the study. The decision of non-rewarming was compliant with international guidelines for 12 (33%) patients. Among the 36 patients for whom the serum potassium was measured at hospital admission, 24 (67%) had a value that - alone - would have indicated ECLS. For 13 of these 24 (54%) patients, the HOPE score was <10%, meaning that ECLS was not indicated. The HOPE estimation of the survival probabilities, when used with a 10% threshold, supported 23 (68%) of the non-rewarming decisions made by the clinicians. Conclusions This study showed a low adherence to international guidelines for hypothermic CA patients. In contrast, most of these non-rewarming decisions made by clinicians would have been compliant with current guidelines based on the HOPE score.
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Affiliation(s)
- Nicolas Hall
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Evelien Cools
- Acute Medicine Department, Anesthesiology Service, Geneva, Switzerland
| | | | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne – Geneva, Switzerland
- Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Switzerland
| | - Bettina Schrag
- Legal Medicine Service, Hospitals Central Institute (ICH), Sion, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Sampani E, Theodorakopoulou M, Iatridi F, Sarafidis P. Hyperkalemia in chronic kidney disease: a focus on potassium lowering pharmacotherapy. Expert Opin Pharmacother 2023; 24:1775-1789. [PMID: 37545002 DOI: 10.1080/14656566.2023.2245756] [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: 05/10/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Hyperkalemia is one of the most common electrolyte disorders in chronic kidney disease (CKD) and is associated with serious adverse outcomes. Hyperkalemia risk is even greater when CKD patients also have additional predisposing conditions such as diabetes or heart failure. Renin-angiotensin-aldosterone-system blockers are first-line treatments for cardio- and nephroprotection, but their use is often limited due to K+ elevation, resulting in high rates of discontinuation. AREAS COVERED This article provides an overview of factors interfering with K+ homeostasis and discusses recent data on newer therapeutic agents used for the treatment of hyperkalemia. A detailed literature search was performed in two major databases (PubMed/MEDLINE and Scopus) up to April 2023. EXPERT OPINION Major clinical trials have tested new and promising kidney protective therapies such as sodium/glucose-cotransporter-2 inhibitors and mineralocorticoid-receptor-antagonists, with promising results. Until recently, the only treatment option for hyperkalemia was the cation-exchanging resin sodium-polystyrene-sulfonate. However, despite its common use, the efficacy and safety data of this drug in the long-term management of hyperkalemia are scarce. During the last decade, two novel orally administered K+-exchanging compounds (patiromer and sodium-zirconium-cyclosilicate) have been approved for the treatment of adults with hyperkalemia, as they both effectively reduce elevated serum K+ and maintain chronically K+ balance within the normal range with an excellent tolerability and no serious adverse events.
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Affiliation(s)
- Erasmia Sampani
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Podsiadło P, Smoleń A, Brožek T, Kosiński S, Balik M, Hymczak H, Cools E, Walpoth B, Nowak E, Dąbrowski W, Miazgowski B, Witt-Majchrzak A, Jędrzejczak T, Reszka K, Segond N, Debaty G, Dudek M, Górski S, Darocha T. Extracorporeal Rewarming Is Associated With Increased Survival Rate in Severely Hypothermic Patients With Preserved Spontaneous Circulation. ASAIO J 2023; 69:749-755. [PMID: 37039862 DOI: 10.1097/mat.0000000000001935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Treatment recommendations for rewarming patients in severe accidental hypothermia with preserved spontaneous circulation have a weak evidence due to the absence of randomized clinical trials. We aimed to compare the outcomes of extracorporeal versus less-invasive rewarming of severely hypothermic patients with preserved spontaneous circulation. We conducted a multicenter retrospective study. The patient population was compiled based on data from the HELP Registry, the International Hypothermia Registry, and a literature review. Adult patients with a core temperature <28°C and preserved spontaneous circulation were included. Patients who underwent extracorporeal rewarming were compared with patients rewarmed with less-invasive methods, using a matched-pair analysis. The study population consisted of 50 patients rewarmed extracorporeally and 85 patients rewarmed with other, less-invasive methods. Variables significantly associated with survival included: lower age; outdoor cooling circumstances; higher blood pressure; higher PaCO 2 ; higher BE; higher HCO 3 ; and the absence of comorbidities. The survival rate was higher in patients rewarmed extracorporeally ( p = 0.049). The relative risk of death was twice as high in patients rewarmed less invasively. Based on our data, we conclude that patients in severe accidental hypothermia with circulatory instability can benefit from extracorporeal rewarming without an increased risk of complications.
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Affiliation(s)
- Paweł Podsiadło
- From the Department of Emergency Medicine, Jan Kochanowski University, Kielce, Poland
| | - Agata Smoleń
- Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin, Poland
| | - Tomáš Brožek
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Sylweriusz Kosiński
- Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Hubert Hymczak
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Evelien Cools
- Department of Acute Medicine, Division of Anaesthesiology, University Hospitals, Geneva, Switzerland
| | - Beat Walpoth
- Emeritus. Department of Cardiovascular Surgery, University Hospitals of Geneva, Switzerland
| | - Ewelina Nowak
- Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Wojciech Dąbrowski
- Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Bartosz Miazgowski
- Emergency Department, University Hospital, Pomeranian Medical University, Szczecin, Poland
| | - Anna Witt-Majchrzak
- Department of Cardiac Surgery Provincial Specialist Hospital, Olsztyn, Poland
| | - Tomasz Jędrzejczak
- Department of Cardiosurgery, Pomeranian Medical University in Szczecin, Poland
| | - Kacper Reszka
- Department of Anaesthesiology and Intensive Care, University Hospital, Łódź, Poland
| | - Nicolas Segond
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Guillaume Debaty
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, Grenoble, France
| | - Michał Dudek
- Department of Emergency Medicine, Faculty of Health Sciences, University of Bielsko-Biała, Poland
| | - Stanisław Górski
- Department of Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Tomasz Darocha
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
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Takayama W, Endo A, Morishita K, Otomo Y. Manual Chest Compression versus Automated Chest Compression Device during Day-Time and Night-Time Resuscitation Following Out-of-Hospital Cardiac Arrest: A Retrospective Historical Control Study. J Pers Med 2023; 13:1202. [PMID: 37623453 PMCID: PMC10455266 DOI: 10.3390/jpm13081202] [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: 06/28/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE We assessed the effectiveness of automated chest compression devices depending on the time of admission based on the frequency of iatrogenic chest injuries, the duration of in-hospital resuscitation efforts, and clinical outcomes among out-of-hospital cardiac arrest (OHCA) patients. METHODS We conducted a retrospective historical control study of OHCA patients in Japan between 2015-2022. The patients were divided according to time of admission, where day-time was considered 07:00-22:59 and night-time 23:00-06:59. These patients were then divided into two categories based on the in-hospital cardiopulmonary resuscitation (IHCPR) device: manual chest compression (mCC) group and automatic chest compression devices (ACCD) group. We used univariate and multivariate ordered logistic regression models adjusted for pre-hospital confounders to evaluate the impact of ACCD use during IHCPR on outcomes (IHCPR duration, CPR-related chest injuries, and clinical outcomes) in the day-time and night-time groups. RESULTS Among 1101 patients with OHCA (day-time, 809; night-time, 292), including 215 patients who underwent ACCD during IHCPR in day-time (26.6%) and 104 patients in night-time group (35.6%), the multivariate model showed a significant association of ACCD use with the outcomes of in-hospital resuscitation and higher rates of return in spontaneous circulation, lower incidence of CPR-related chest injuries, longer in-hospital resuscitation durations, greater survival to Emergency Department and hospital discharge, and greater survival with good neurological outcome to hospital discharge, though only in the night-time group. CONCLUSIONS Patients who underwent ACCD during in-hospital resuscitation at night had a significantly longer duration of in-hospital resuscitation, a lower incidence of CPR-related chest injuries, and better outcomes.
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Affiliation(s)
- Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan; (K.M.); (Y.O.)
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
| | - Akira Endo
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
- Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura 300-0028, Ibaraki, Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan; (K.M.); (Y.O.)
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan; (K.M.); (Y.O.)
- Department of Acute Critical Care and Disaster Medicine, Graduate School of Tokyo Medical and Dental University, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-0034, Japan;
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Nacer DT, de Sousa RMC, Miranda AL. Outcomes after Clinical and Traumatic Out-of-Hospital Cardiac Arrest. Arq Bras Cardiol 2023; 120:e20220551. [PMID: 37493651 PMCID: PMC10374265 DOI: 10.36660/abc.20220551] [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: 08/29/2022] [Revised: 02/27/2023] [Accepted: 04/05/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Data on out-of-hospital cardiac arrest are still scarce, very varied, and indicate a poor prognosis for traumatic events. OBJECTIVES To describe the out-of-hospital/in-hospital survival, survival time, and neurological conditions of those treated by advanced life support units and submitted to cardiopulmonary resuscitation and compare the results of clinical and traumatic cardiac arrests. METHODS This is a cohort study carried out in three stages; in the first two, data were collected from the Mobile Emergency Care Service forms and medical records; then, the Brain Performance Category Scale was applied in the third stage. The sample consisted of resuscitated victims aged ≥18 years. Fisher's and log-rank tests were used to compare the causes, considering a significance level of 5%. RESULTS 852 patients were analyzed; 20.66% were hospitalized, 4.23% survived until transfer or discharge, and 58.33% had a favorable outcome one year after arrest. There was an association between pre/in-hospital survival and the nature of the occurrence (p=0.026), but there was no difference between the survival curves (p=0.6). CONCLUSIONS Survival of hospitalization after out-of-hospital cardiac arrest was low; however, most who survived to be discharged achieved a favorable outcome after one year. The survival time of those hospitalized after clinical and traumatic events were similar, but pre-hospital survival was higher among trauma patients.
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Affiliation(s)
- Daiana Terra Nacer
- Universidade de São PauloEscola de EnfermagemSão PauloSPBrasilUniversidade de São Paulo – Escola de Enfermagem, São Paulo, SP – Brasil
| | - Regina Márcia Cardoso de Sousa
- Universidade de São PauloEscola de EnfermagemSão PauloSPBrasilUniversidade de São Paulo – Escola de Enfermagem, São Paulo, SP – Brasil
| | - Anna Leticia Miranda
- Universidade Federal de Minas GeraisFaculdade de MedicinaBelo HorizonteMGBrasilUniversidade Federal de Minas Gerais – Faculdade de Medicina – Campus Saúde, Belo Horizonte, MG – Brasil
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Rauch S, Kompatscher J, Clara A, Öttl I, Strapazzon G, Kaufmann M. Critically buried avalanche victims can develop severe hypothermia in less than 60 min. Scand J Trauma Resusc Emerg Med 2023; 31:29. [PMID: 37322530 DOI: 10.1186/s13049-023-01092-y] [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: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND A major challenge in the management of avalanche victims in cardiac arrest is differentiating hypothermic from non-hypothermic cardiac arrest, as management and prognosis differ. Duration of burial with a cutoff of 60 min is currently recommended by the resuscitation guidelines as a parameter to aid in this differentiation However, the fastest cooling rate under the snow reported so far is 9.4 °C per hour, suggesting that it would take 45 min to cool below 30 °C, which is the temperature threshold below which a hypothermic cardiac arrest can occur. CASE PRESENTATION We describe a case with a cooling rate of 14 °C per hour, assessed on site with an oesophageal temperature probe. This is by far the most rapid cooling rate after critical avalanche burial reported in the literature and further challenges the recommended 60 min threshold for triage decisions. The patient was transported under continuous mechanical CPR to an ECLS facility and rewarmed with VA-ECMO, although his HOPE score was 3% only. After three days he developed brain death and became an organ donor. CONCLUSIONS With this case we would like to underline three important aspects: first, whenever possible, core body temperature should be used instead of burial duration to make triage decisions. Second, the HOPE score, which is not well validated for avalanche victims, had a good discriminatory ability in our case. Third, although extracorporeal rewarming was futile for the patient, he donated his organs. Thus, even if the probability of survival of a hypothermic avalanche patient is low based on the HOPE score, ECLS should not be withheld by default and the possibility of organ donation should be considered.
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Affiliation(s)
- Simon Rauch
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy.
- Department of Anaesthesia and Intensive Care Medicine, Hospital of Merano, Via Rossini 5, Merano, 39012, Italy.
- Aiut Alpin Dolomites Helicopter Emergency Medical Service, Pontives 24, Laion, 39040, Italy.
| | - Julia Kompatscher
- Department of Emergency Medicine, Anaesthesia and Intensive Care Medicine, Hospital of Bolzano, Via Lorenz Böhler, 5, Bolzano, 39100, Italy
| | - Andreas Clara
- Aiut Alpin Dolomites Helicopter Emergency Medical Service, Pontives 24, Laion, 39040, Italy
- Corpo Nazionale Soccorso Alpino e Speleologico - CNSAS, Milano, Italy
| | - Iris Öttl
- Department of Emergency Medicine, Anaesthesia and Intensive Care Medicine, Hospital of Bolzano, Via Lorenz Böhler, 5, Bolzano, 39100, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Via Ipazia 2, Bolzano, 39100, Italy
- Corpo Nazionale Soccorso Alpino e Speleologico - CNSAS, Milano, Italy
| | - Marc Kaufmann
- Department of Emergency Medicine, Anaesthesia and Intensive Care Medicine, Hospital of Bolzano, Via Lorenz Böhler, 5, Bolzano, 39100, Italy
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Aranda-Domene R, Orenes-Piñero E, Arribas-Leal JM, Canovas-Lopez S, Hernández-Cascales J. Evidence for a lack of inotropic and chronotropic effects of glucagon and glucagon receptors in the human heart. Cardiovasc Diabetol 2023; 22:128. [PMID: 37254135 DOI: 10.1186/s12933-023-01859-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/14/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Glucagon is thought to increase heart rate and contractility by stimulating glucagon receptors and increasing 3',5'-cyclic adenosine monophosphate (cAMP) production in the myocardium. This has been confirmed in animal studies but not in the human heart. The cardiostimulatory effects of glucagon have been correlated with the degree of cardiac dysfunction, as well as with the enzymatic activity of phosphodiesterase (PDE), which hydrolyses cAMP. In this study, the presence of glucagon receptors in the human heart and the inotropic and chronotropic effects of glucagon in samples of failing and nonfailing (NF) human hearts were investigated. METHODS Concentration‒response curves for glucagon in the absence and presence of the PDE inhibitor IBMX were performed on samples obtained from the right (RA) and left atria (LA), the right (RV) and left ventricles (LV), and the sinoatrial nodes (SNs) of failing and NF human hearts. The expression of glucagon receptors was also investigated. Furthermore, the inotropic and chronotropic effects of glucagon were examined in rat hearts. RESULTS In tissues obtained from failing and NF human hearts, glucagon did not exert inotropic or chronotropic effects in the absence or presence of IBMX. IBMX (30 µM) induced a marked increase in contractility in NF hearts (RA: 83 ± 28% (n = 5), LA: 80 ± 20% (n = 5), RV: 75 ± 12% (n = 5), and LV: 40 ± 8% (n = 5), weaker inotropic responses in the ventricular myocardium of failing hearts (RV: 25 ± 10% (n = 5) and LV: 10 ± 5% (n = 5) and no inotropic responses in the atrial myocardium of failing hearts. IBMX (30 µM) increased the SN rate in failing and NF human hearts (27.4 ± 3.0 beats min-1, n = 10). In rat hearts, glucagon induced contractile and chronotropic responses, but only contractility was enhanced by 30 µM IBMX (maximal inotropic effect of glucagon 40 ± 8% vs. 75 ± 10%, in the absence or presence of IBMX, n = 5, P < 0.05; maximal chronotropic response 77.7 ± 6.4 beats min-1 vs. 73 ± 11 beats min-1, in the absence or presence of IBMX, n = 5, P > 0.05). Glucagon receptors were not detected in the human heart samples. CONCLUSIONS Our results conflict with the view that glucagon induces inotropic and chronotropic effects and that glucagon receptors are expressed in the human heart.
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Affiliation(s)
- Ramón Aranda-Domene
- Department of Cardiovascular Surgery, Hospital CSV Arrixaca, El Palmar, 30120, Murcia, Spain
| | - Esteban Orenes-Piñero
- Proteomic Unit, Laboratorio Investigación Biosanitaria, Av.Buenavista, 32, El Palmar, 30120, Murcia, Spain
| | - José María Arribas-Leal
- Department of Cardiovascular Surgery, Hospital CSV Arrixaca, El Palmar, 30120, Murcia, Spain
| | - Sergio Canovas-Lopez
- Department of Cardiovascular Surgery, Hospital CSV Arrixaca, El Palmar, 30120, Murcia, Spain
| | - Jesús Hernández-Cascales
- Department of Pharmacology, Faculty Medicine, Edificio LAIB, University of Murcia., 6ª Planta. Av. Buenavista, 32, El Palmar, 30120, Murcia, Spain.
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Barcala-Furelos R, Carracedo-Rodríguez E, Lorenzo-Martínez M, Alonso-Calvete A, Otero-Agra M, Jorge-Soto C. Assessment of over-the-head resuscitation method in an inflatable rescue boat sailing at full speed. A non-inferiority pilot study. Am J Emerg Med 2023; 70:70-74. [PMID: 37210976 DOI: 10.1016/j.ajem.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Drowning is a public health problem. Interrupting the drowning process as soon as possible and starting cardiopulmonary resuscitation (CPR) can improve survival rates. Inflatable rescue boats (IRBs) are widely used worldwide to rescue drowning victims. Performing CPR in special circumstances requires adjusting the position based on the environment and space available. The aim of this study was to assess the quality of over-the-head resuscitation performed by rescuers aboard an IRB in comparison to standard CPR. METHODS A quasi-experimental, quantitative, cross-sectional pilot study was conducted. Ten professional rescuers performed 1 min of simulated CPR on a QCPR Resuscy Anne manikin (Laerdal, Norway) sailing at 20 knots using two different techniques: 1) standard CPR (S-CPR) and 2) over-the-head CPR (OTH-CPR). Data were recorded through the APP QCPR Training (Laerdal, Norway). RESULTS The quality of CPR was similar between S-CPR (61%) and OTH-CPR (66%), with no statistically significant differences (p = 0.585). Both the percentage of compressions and the percentage of correct ventilations did not show significant differences (p > 0.05) between the techniques. CONCLUSION The rescuers can perform CPR maneuvers with acceptable quality in the IRB. The OTH-CPR technique did not show inferiority compared to S-CPR, making it a viable alternative when boat space or rescue conditions do not allow the conventional technique to be performed.
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Affiliation(s)
- Roberto Barcala-Furelos
- REMOSS Research Group, Universidade de Vigo, Campus A Xunqueira s/n, 36005 Pontevedra, Spain
| | | | - Miguel Lorenzo-Martínez
- REMOSS Research Group, Universidade de Vigo, Campus A Xunqueira s/n, 36005 Pontevedra, Spain
| | - Alejandra Alonso-Calvete
- REMOSS Research Group, Universidade de Vigo, Campus A Xunqueira s/n, 36005 Pontevedra, Spain; Facultade de Fisioterapia, Universidade de Vigo, Campus A Xunqueira s/n, 36005 Pontevedra, Spain.
| | - Martín Otero-Agra
- REMOSS Research Group, Universidade de Vigo, Campus A Xunqueira s/n, 36005 Pontevedra, Spain; School of Nursing, Universidade de Vigo, Pontevedra, Spain
| | - Cristina Jorge-Soto
- Clinursid Research Group, Faculty of Nursing, University of Santiago de Compostela, Spain; SICRUS Research Group, Health Research Institute of Santiago de Compostela (IDIS), Spain
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Elsayed ME, Schick B, Woywodt A, Palmer BF. The hypokalaemia that came from the cold. Clin Kidney J 2023; 16:768-772. [PMID: 37151424 PMCID: PMC10157748 DOI: 10.1093/ckj/sfad036] [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: 11/22/2022] [Indexed: 03/09/2023] Open
Abstract
While electrolyte disorders are common in nephrologists' clinical practice, hypothermia is a condition that nephrologists rarely encounter. Hypothermia can induce several pathophysiological effects on the human body, including hypokalaemia, which is reversible with rewarming. Despite growing evidence from animal research and human studies, the underlying mechanisms of hypothermia-induced hypokalaemia remain unclear. Boubes and colleagues recently presented a case series of hypokalaemia during hypothermia and rewarming, proposing a novel hypothesis for the underlying mechanisms. In this editorial, we review the current knowledge about hypothermia and associated electrolyte changes with insights into the effects of hypothermia on renal physiology.
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Affiliation(s)
- Mohamed E Elsayed
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Benedikt Schick
- Department of Anaesthesiology and Intensive Care Medicine, Ulm University Medical Centre, Ulm, Germany
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Biff F Palmer
- Department of Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, USA
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Almutairi MK, Alqirnas MQ, Altwim AM, Alhamadh MS, Alkhashan M, Aljahdali N, Albdah B. Outcomes of Pediatric Traumatic Cardiac Arrest: A 15-year Retrospective Study in a Tertiary Center in Saudi Arabia. Cureus 2023; 15:e39598. [PMID: 37384094 PMCID: PMC10296779 DOI: 10.7759/cureus.39598] [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: 05/28/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND/OBJECTIVE Traumatic cardiac arrest (TCA) is the cessation of cardiac pumping activity secondary to blunt or penetrating trauma. The aim of this study is to identify the outcomes of traumatic cardiac arrest in pediatric patients within the local community and report the causes and resuscitation management for the defined cases. METHODS This was a retrospectively conducted cohort study that took place in King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children Hospital (KASCH) from 2005 to 2021, Riyadh, Kingdom of Saudi Arabia. The study population involved pediatric patients aged 14 years or less who were admitted to our Emergency Department (ED) and had a traumatic cardiac arrest in the ED. RESULTS There were 26,510 trauma patients, and only 56 were eligible for inclusion. More than half (60.71%, n= 34) of the patients were males. Patients aged four years or less constituted 51.79% (n= 29) of the included cases. The majority of patients were Saudis (89.29%, n= 50). The majority of the patients had cardiac arrest prior to ED admission (78.57%, n= 44). The majority (89.29%, n= 50) had a GCS of 3 at ED arrival. The most frequently observed first cardiac arrest rhythm was asystole, followed by pulseless electrical activity and ventricular fibrillation, accounting for 74.55%, 23.64%, and 1.82%, respectively. CONCLUSION Pediatric TCA is high acuity. Children who experience TCA have dreadful outcomes, and survivors can suffer serious neurological impairments. We provided the experience of one of the largest trauma centers in Saudi Arabia to standardize the approach for managing TCA and, hopefully, improve its outcomes.
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Affiliation(s)
- Mohammed K Almutairi
- Department of Emergency Medicine, King Abdullah Specialized Children Hospital, Riyadh, SAU
| | - Muhannad Q Alqirnas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - Moustafa S Alhamadh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Munira Alkhashan
- Department of Emergency Medicine, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Nouf Aljahdali
- Department of Emergency Medicine, King Abdullah Specialized Children Hospital, Riyadh, SAU
| | - Bayan Albdah
- Section of Biostatistics, Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, SAU
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David JS, James A, Orion M, Selves A, Bonnet M, Glasman P, Vacheron CH, Raux M. Thromboelastometry-guided haemostatic resuscitation in severely injured patients: a propensity score-matched study. Crit Care 2023; 27:141. [PMID: 37055832 PMCID: PMC10103518 DOI: 10.1186/s13054-023-04421-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND To accelerate the diagnosis and treatment of trauma-induced coagulopathy (TIC), viscoelastic haemostatic assays (VHA) are increasingly used worldwide, although their value is still debated, with a recent randomised trial showing no improvement in outcome. The objective of this retrospective study was to compare 2 cohorts of injured patients in which TIC was managed with either a VHA-based algorithm or a conventional coagulation test (CCT)-based algorithm. METHODS Data were retrieved from 2 registries and patients were included in the study if they received at least 1 unit of red blood cell in the first 24 h after admission. A propensity score, including sex, age, blunt vs. penetrating, systolic blood pressure, GCS, ISS and head AIS, admission lactate and PTratio, tranexamic acid administration, was then constructed. Primary outcome was the proportion of subjects who were alive and free of massive transfusion (MT) at 24 h after injury. We also compared the cost for blood products and coagulation factors. RESULTS From 2012 to 2019, 7250 patients were admitted in the 2 trauma centres, and among these 624 were included in the study (CCT group: 380; VHA group: 244). After propensity score matching, 215 patients remained in each study group without any significant difference in demographics, vital signs, injury severity, or laboratory analysis. At 24 h, more patients were alive and free of MT in the VHA group (162 patients, 75%) as compared to the CCT group (112 patients, 52%; p < 0.01) and fewer patients received MT (32 patients, 15% vs. 91 patients, 42%, p < 0.01). However, no significant difference was observed for mortality at 24 h (odds ratio 0.94, 95% CI 0.59-1.51) or survival at day 28 (odds ratio 0.87, 95% CI 0.58-1.29). Overall cost of blood products and coagulation factors was dramatically reduced in the VHA group as compared to the CCT group (median [interquartile range]: 2357 euros [1108-5020] vs. 4092 euros [2510-5916], p < 0.001). CONCLUSIONS A VHA-based strategy was associated with an increase of the number of patients alive and free of MT at 24 h together with an important reduction of blood product use and associated costs. However, that did not translate into an improvement in mortality.
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Affiliation(s)
- Jean-Stéphane David
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Bénite Cedex, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France.
| | - Arthur James
- GRC 29, AP-HP, DMU DREAM, Department of Anaesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Maxime Orion
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Bénite Cedex, France
| | - Agathe Selves
- GRC 29, AP-HP, DMU DREAM, Department of Anaesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Mélody Bonnet
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Bénite Cedex, France
| | - Pauline Glasman
- GRC 29, AP-HP, DMU DREAM, Department of Anaesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Charles-Hervé Vacheron
- Department of Anesthesia and Intensive Care, Groupe Hospitalier Sud, Hospices Civils de Lyon (HCL), Pierre Bénite Cedex, France
- Biometrics and Evolutionary Biology Laboratory, Biostatistics-Health Team, HCL, Villeurbanne, France
- Division of Public Health, Department of Biostatistics and Bioinformatics, Lyon, France
| | - Mathieu Raux
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, Sorbonne Université, Paris, France
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37
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Heikkilä E, Jousi M, Nurmi J. Differential diagnosis and cause-specific treatment during out-of-hospital cardiac arrest: a retrospective descriptive study. Scand J Trauma Resusc Emerg Med 2023; 31:19. [PMID: 37041592 PMCID: PMC10091670 DOI: 10.1186/s13049-023-01080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The cardiopulmonary resuscitation (CPR) guidelines recommend identifying and correcting the underlying reversible causes of out-of-hospital cardiac arrest (OHCA). However, it is uncertain how often these causes can be identified and treated. Our aim was to estimate the frequency of point of care ultrasound examinations, blood sample analyses and cause-specific treatments during OHCA. METHODS We performed a retrospective study in a physician-staffed helicopter emergency medical service (HEMS) unit. Data on 549 non-traumatic OHCA patients who were undergoing CPR at the arrival of the HEMS unit from 2016 to 2019 were collected from the HEMS database and patient records. We also recorded the frequency of ultrasound examinations, blood sample analyses and specific therapies provided during OHCA, such as procedures or medications other than chest compressions, airway management, ventilation, defibrillation, adrenaline or amiodarone. RESULTS Of the 549 patients, ultrasound was used in 331 (60%) and blood sample analyses in 136 (24%) patients during CPR. A total of 85 (15%) patients received cause-specific treatment, the most common ones being transportation to extracorporeal CPR and percutaneous coronary intervention (PCI) (n = 30), thrombolysis (n = 23), sodium bicarbonate (n = 17), calcium gluconate administration (n = 11) and fluid resuscitation (n = 10). CONCLUSION In our study, HEMS physicians deployed ultrasound or blood sample analyses in 84% of the encountered OHCA cases. Cause-specific treatment was administered in 15% of the cases. Our study demonstrates the frequent use of differential diagnostic tools and relatively infrequent use of cause-specific treatment during OHCA. Effect on protocol for differential diagnostics should be evaluated for more efficient cause specific treatment during OHCA.
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Affiliation(s)
- Elina Heikkilä
- Department of Emergency Medicine and Services, University of Helsinki and University Hospital, Helsinki, Finland
| | - Milla Jousi
- Department of Emergency Medicine and Services, University of Helsinki and University Hospital, Helsinki, Finland
| | - Jouni Nurmi
- Department of Emergency Medicine and Services, University of Helsinki and University Hospital, Helsinki, Finland.
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38
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Delvau N, Penaloza A, Franssen V, Thys F, Roy PM, Hantson P. Unexpected carboxyhemoglobin half-life during cardiopulmonary resuscitation: a case report. Int J Emerg Med 2023; 16:22. [PMID: 36944931 PMCID: PMC10029238 DOI: 10.1186/s12245-023-00492-2] [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: 11/24/2021] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cardiac arrest (CA) following CO poisoning (CO-induced CA) exposes patients to an extremely high risk of mortality and remains challenging to treat effectively. Terminal carboxyhemoglobin elimination half-life (COHbt1/2) is critically affected by ventilation, oxygen therapy, and cardiac output, which are severely affected conditions in cases of CA. CASE PRESENTATION Asystole occurred in an 18-year-old woman after unintentional exposure to CO in her bathroom. Cardiopulmonary resuscitation (CPR) was started immediately, including mechanical ventilation with a fraction of inspired oxygen (FiO2) of 1.0 and external chest compressions with a LUCAS® device. CPR was stopped after 101 min, as it was unsuccessful. During this period, we calculated a COHbt1/2 of 40.3 min using a single compartmental model. CONCLUSIONS This result suggests that prolongation of CPR time needed to back COHb at 10%, a level more compatible with successful return of spontaneous circulation (ROSC), could be compatible with a realistic CPR time. Calculating COHbt1/2 during CPR may help with decision-making regarding the optimal duration of resuscitation efforts and further with HBO2 or ECLS. Further evidence-based data are needed to confirm this result.
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Affiliation(s)
- Nicolas Delvau
- Departments of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium.
| | - Andrea Penaloza
- Departments of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Véronique Franssen
- Departments of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Frédéric Thys
- Emergency Department, GHDC: Grand Hopital de Charleroi, 6000, Charleroi, Belgium
| | - Pierre-Marie Roy
- Emergency Department, CHU Angers: Centre Hospitalier Universitaire d'Angers, Angers Cedex 01, 49033, Angers, France
| | - Philippe Hantson
- Departments of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
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39
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Sumphaongern T, Yamahara E, Wakita R. Sudden Cardiac Arrest in a Dental Patient Awaiting Examination. Anesth Prog 2023; 70:25-30. [PMID: 36995959 PMCID: PMC10069538 DOI: 10.2344/anpr-69-04-05] [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: 11/05/2021] [Accepted: 09/16/2022] [Indexed: 03/31/2023] Open
Abstract
Sudden cardiac arrest (SCA) is an uncommon event in dental practice; however, the frequency of dentists encountering SCA and other major medical emergencies is increasing. We report the successful resuscitation of a patient who developed SCA while awaiting examination and treatment at a dental hospital. The emergency response team was called upon, and cardiopulmonary resuscitation/basic life support (CPR/BLS), including chest compression and mask ventilation, was promptly initiated. An automated external defibrillator was used, which indicated that the patient's cardiac rhythm was unsuitable for electrical defibrillation. The patient returned to spontaneous circulation after 3 cycles of CPR and intravenous epinephrine. The knowledge and skill levels of dentists regarding resuscitation under emergency circumstances should be addressed. Emergency response systems must be well established, and CPR/BLS knowledge and training should be updated regularly, including optimal management of both shockable and nonshockable rhythms.
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Affiliation(s)
- Thunshuda Sumphaongern
- Instructor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Erika Yamahara
- Graduate Research Student, Department of Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Wakita
- Associate Professor, Department of Dental Anesthesiology and Orofacial Pain Management, Tokyo Medical and Dental University, Tokyo, Japan
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40
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Tian R, Li R, Zhou X. Recent Progresses in Non-Dialysis Chronic Kidney Disease Patients with Hyperkalemia: Outcomes and Therapeutic Strategies. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020353. [PMID: 36837554 PMCID: PMC9966910 DOI: 10.3390/medicina59020353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
Chronic kidney disease (CKD) affects about 10% of the world's population. Hyperkalemia is a life-threatening complication in patients with CKD, as it is associated with adverse cardiovascular and kidney outcomes. There are still many challenges and questions to address to improve the currently available therapeutic strategies to treat hyperkalemia, such as how to approach the emergency management of hyperkalemia. In recent years, in addition to novel oral potassium binders, great progress has been made in the application of novel kidney protective strategies, such as mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors (SGLT2i) in hyperkalemia therapy. This review will discuss the recent advances from clinical trials in the effective management of hyperkalemia in non-dialysis CKD patients, enhancing the knowledge of physicians and internists concerning these newer agents and providing a helpful reference for clinical practice.
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Affiliation(s)
- Ruixue Tian
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan 030012, China
| | - Rongshan Li
- Department of Nephrology, Shanxi Provincial People’s Hospital, The Fifth Clinical Medical College of Shanxi Medical University, Shanxi Kidney Disease Institute, 29 Shuang Ta East Street, Taiyuan 030012, China
- Correspondence: (R.L.); (X.Z.)
| | - Xiaoshuang Zhou
- Department of Nephrology, Shanxi Provincial People’s Hospital, The Fifth Clinical Medical College of Shanxi Medical University, Shanxi Kidney Disease Institute, 29 Shuang Ta East Street, Taiyuan 030012, China
- Correspondence: (R.L.); (X.Z.)
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41
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Kraai E, Wray TC, Ball E, Tawil I, Mitchell J, Guliani S, Dettmer T, Marinaro J. E-CPR in Cardiac Arrest due to Accidental Hypothermia Using Intensivist Cannulators: A Case Series of Nine Consecutive Patients. J Intensive Care Med 2023; 38:215-219. [PMID: 35876344 DOI: 10.1177/08850666221116594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Severe accidental hypothermia (AH) accounts for over 1300 deaths/year in the United States. Early extracorporeal life support (ECLS) is recommended for hypothermic cardiac arrest. We describe the use of a rapid-deployment extracorporeal cardiopulmonary resuscitation (E-CPR) team using intensivist physicians (IPs) as cannulators and report the outcomes of consecutive patients cannulated for ECLS to manage cardiac arrest due to AH. Methods: We reviewed all patients managed with veno-arterial (V-A) ECLS for hypothermic cardiac arrest between January 1, 2017 and November 1, 2021. For each patient- age, sex, cause of hypothermia, initial core temperature, initial rhythm, time from arrest to cannulation, cannula configuration, pH, lactate, potassium, cannulation complications, duration of ECLS, hospital length of stay, mortality, and cerebral performance category (CPC) at discharge were reviewed. Results: Nine consecutive patients were identified that underwent V-A ECLS for cardiac arrest due to AH. Seven (78%) were witnessed arrests. Initial rhythm was ventricular fibrillation (VF) in eight patients and pulseless electrical activity (PEA) in one. The mean initial core temperature was 23.8 degrees Celsius. The mean time from arrest to cannulation was 58 min (range 17 to 251 min). There were no complications related to cannulation. The mean duration of ECLS was 39.1 h. All nine patients were discharged alive with a Cerebral Performance score of one or two. Conclusion: In this case series of consecutive patients reporting intensivist-deployed E-CPR for cardiac arrest due to AH, all patients survived to discharge with a favorable neurologic outcome. A rapidly available E-CPR team utilizing intensivist cannulators may improve outcomes in patients with cardiac arrest due to AH.
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Affiliation(s)
- Erik Kraai
- Department of Internal Medicine, Center for Adult Critical Care, 21764University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Trenton C Wray
- Department of Emergency Medicine, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Emily Ball
- Department of Emergency Medicine, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Isaac Tawil
- Department of Emergency Medicine, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jessica Mitchell
- Department of Emergency Medicine, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sundeep Guliani
- Department of Surgery, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Todd Dettmer
- Department of Emergency Medicine, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Jonathan Marinaro
- Department of Emergency Medicine, Center for Adult Critical Care, 12289University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Weber S, Kulla M, Lechner R. Herz-Kreislauf-Stillstand im alpinen Gelände. FLUGMEDIZIN · TROPENMEDIZIN · REISEMEDIZIN - FTR 2023. [DOI: 10.1055/a-2003-9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
ZUSAMMENFASSUNGDie Anzahl von Touristen und Freizeitsportlern in Bergregionen nimmt zu. Im Verhältnis dazu steigt auch die Zahl an Notfallsituationen wie Herz-Kreislauf-Stillstand. Wiederbelebungsmaßnahmen in diesen Umgebungsbedingungen sind anspruchsvoll. Eine besondere Bedeutung in diesem Rahmen hat die prolongierte kardiopulmonale Reanimation.
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Affiliation(s)
- Sebastian Weber
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Martin Kulla
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
| | - Raimund Lechner
- Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm
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43
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Tanaka H, Matsunaga S, Furuta M, Kato R, Takahashi S, Takeda J, Nakao M, Nakamura E, Nii M, Yamashita T, Yamahata Y, Enomoto N, Tsuji M, Baba S, Hosokawa Y, Maenaka T, Sakurai A. Maternal cardiopulmonary resuscitation. J Obstet Gynaecol Res 2023; 49:54-67. [PMID: 36257320 DOI: 10.1111/jog.15466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 01/20/2023]
Abstract
The perinatal resuscitation history in Japan is short, with the earliest efforts in the field of neonatology. In contrast, the standardization and dissemination of maternal resuscitation is lagging. With the establishment of the Maternal Death Reporting Project and the Maternal Death Case Review and Evaluation Committee in 2010, with the aim of reducing maternal deaths, the true situation of maternal deaths came to light. Subsequently, in 2015, the Japan Council for the Dissemination of Maternal Emergency Life Support Systems (J-CIMELS) was established to educate and disseminate simulations in maternal emergency care; training sessions on maternal resuscitation are now conducted in all prefectures. Since the launch of the project and council, the maternal mortality rate in Japan (especially due to obstetric critical hemorrhage) has gradually decreased. This has been probably achieved due to the tireless efforts of medical personnel involved in perinatal care, as well as the various activities conducted so far. However, there are no standardized guidelines for maternal resuscitation yet. Therefore, a committee was set up within the Japan Resuscitation Council to develop a maternal resuscitation protocol, and the Guidelines for Maternal Resuscitation 2020 was created in 2021. These guidelines are expected to make the use of high-quality resuscitation methods more widespread than ever before. This presentation will provide an overview of the Guidelines for Maternal Resuscitation 2020.
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Affiliation(s)
- Hiroaki Tanaka
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | | | - Marie Furuta
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Rie Kato
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Shinji Takahashi
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Jun Takeda
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Masahiro Nakao
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Eishin Nakamura
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Masafumi Nii
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | | | | | - Naosuke Enomoto
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Makoto Tsuji
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Shiniji Baba
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Yuki Hosokawa
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Takahide Maenaka
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
| | - Atsushi Sakurai
- Japan Resuscitation Council, Maternal Resuscitation Group, Tokyo, Japan
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44
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Serebriakoff P, Cafferkey J, de Wit K, Horner DE, Reed MJ. Pulmonary embolism management in the emergency department: part 2. J Accid Emerg Med 2023; 40:69-75. [PMID: 35383107 DOI: 10.1136/emermed-2021-212001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/20/2022] [Indexed: 01/10/2023]
Abstract
Pulmonary embolism (PE) can present with a range of severity. Prognostic risk stratification is important for efficacious and safe management. This second of two review articles discusses the management of high-, intermediate- and low-risk PE. We discuss strategies to identify patients suitable for urgent outpatient care in addition to identification of patients who would benefit from thrombolysis. We discuss specific subgroups of patients where optimal treatment differs from the usual approach and identify emerging management paradigms exploring new therapies and subgroups.
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Affiliation(s)
| | - John Cafferkey
- Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, UK
| | - Kerstin de Wit
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Daniel E Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, UK .,Acute Care Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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45
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Evaluation of Care Outcomes of Patients Receiving Hyperkalemia Treatment With Insulin in Acute Care Tertiary Hospital Emergency Department. J Emerg Nurs 2023; 49:99-108. [PMID: 36266095 DOI: 10.1016/j.jen.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Treatment of hyperkalemia using intravenous insulin can result in severe hypoglycemia, but regular blood glucose monitoring is not standardized. This study aimed to (i) explore the demographics of adult patients receiving hyperkalemia treatment and (ii) identify the incidence rate of hypoglycemia and associated demographic or clinical characteristics. METHODS A descriptive design with prospective data collection was used. This study recruited 135 patients who received hyperkalemia treatment in the emergency department. Structured blood glucose monitoring was conducted at 1, 2, 4, and 6 hours after receiving intravenous insulin. Univariate analyses of association between demographic and clinical variables and hypoglycemia outcome were performed. RESULTS There were 31 hypoglycemic events, with 11.9%, 7.4%, 2.2%, and 1.5% occurring at the 1, 2, 4, and 6 hours after treatment. The logit regression showed no significantly increased risk of hypoglycemia in terms of the demographic and clinical variables. DISCUSSION The variation in blood glucose response observed in this study combined with the high incidences of hypolycaemia indicated the need for frequent and longer duration of monitoring for patients who were being treated for hyperkalaemia with IDT.
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46
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Emektar E. Acute hyperkalemia in adults. Turk J Emerg Med 2023; 23:75-81. [PMID: 37169032 PMCID: PMC10166290 DOI: 10.4103/tjem.tjem_288_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 03/06/2023] Open
Abstract
Hyperkalemia is a common, life-threatening medical situation in chronic renal disease patients in the emergency department (ED). Since hyperkalemia does not present with any specific symptom, it is difficult to diagnose clinically. Hyperkalemia causes broad and dramatic medical presentations including cardiac arrhythmia and sudden death. Hyperkalemia is generally determined through serum measurement in the laboratory. Treatment includes precautions to stabilize cardiac membranes, shift potassium from the extracellular to the intracellular, and increase potassium excretion. The present article discusses the management of hyperkalemia in the ED in the light of current evidence.
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Katzenschlager S, Obermaier M, Kuhner M, Spöttl W, Dietrich M, Weigand MA, Weilbacher F, Popp E. [Focus on emergency medicine 2021/2022-Summary of selected emergency medicine studies]. DIE ANAESTHESIOLOGIE 2023; 72:130-142. [PMID: 36602555 PMCID: PMC9813891 DOI: 10.1007/s00101-022-01245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Affiliation(s)
- S. Katzenschlager
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Obermaier
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Kuhner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - W. Spöttl
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Dietrich
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. A. Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - F. Weilbacher
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - E. Popp
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Lou YS, Lin CS, Fang WH, Lee CC, Wang CH, Lin C. Development and validation of a dynamic deep learning algorithm using electrocardiogram to predict dyskalaemias in patients with multiple visits. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 4:22-32. [PMID: 36743876 PMCID: PMC9890087 DOI: 10.1093/ehjdh/ztac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Aims Deep learning models (DLMs) have shown superiority in electrocardiogram (ECG) analysis and have been applied to diagnose dyskalaemias. However, no study has explored the performance of DLM-enabled ECG in continuous follow-up scenarios. Therefore, we proposed a dynamic revision of DLM-enabled ECG to use personal pre-annotated ECGs to enhance the accuracy in patients with multiple visits. Methods and results We retrospectively collected 168 450 ECGs with corresponding serum potassium (K+) levels from 103 091 patients as development samples. In the internal/external validation sets, the numbers of ECGs with corresponding K+ were 37 246/47 604 from 13 555/20 058 patients. Our dynamic revision method showed better performance than the traditional direct prediction for diagnosing hypokalaemia [area under the receiver operating characteristic curve (AUC) = 0.730/0.720-0.788/0.778] and hyperkalaemia (AUC = 0.884/0.888-0.915/0.908) in patients with multiple visits. Conclusion Our method has shown a distinguishable improvement in DLMs for diagnosing dyskalaemias in patients with multiple visits, and we also proved its application in ejection fraction prediction, which could further improve daily clinical practice.
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Affiliation(s)
- Yu-Sheng Lou
- Graduate Institutes of Life Sciences, National Defense Medical Center, No.161, Min-Chun E. Rd., Sec. 6, Neihu, Taipei 114, Taiwan, Republic of China,School of Public Health, National Defense Medical Center, No. 161, Min-Chun E. Rd., Section 6, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center,, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China
| | - Wen-Hui Fang
- Department of Family and Community Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chia-Cheng Lee
- Medical Informatics Office, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng- Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China,Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd., Section 2, Neihu, Taipei 114, Taiwan, Republic of China,Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Min-Chun E. Rd., Section 6, Neihu, Taipei 114, Taiwan, Republic of China
| | - Chin Lin
- Corresponding author. Tel: +886 2 87923100 #18574, Fax: +886 2 87923147,
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Rubens M, Kanaris C. Fifteen-minute consultation: Emergency management of children presenting with hyperkalaemia. Arch Dis Child Educ Pract Ed 2022; 107:344-350. [PMID: 34344762 DOI: 10.1136/archdischild-2021-322080] [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] [Received: 03/28/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022]
Abstract
Hyperkalaemia can lead to life-threatening cardiac arrhythmias. A good understanding of the physiological basis of management can help us rationalise treatment and reduce plasma potassium levels efficiently and effectively. Management focuses on avoidance of arrythmias, rapid intracellular movement of potassium and finally reduction of total body potassium. Fluid management in hyperkalaemia should be carefully considered, with balanced solutions providing theoretical benefits compared to 0.9% saline in certain situations.
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Affiliation(s)
- Matthew Rubens
- Department of Paediatrics, North Middlesex University Hospital, London, UK
| | - Constantinos Kanaris
- Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK .,Blizard Institute, Queen Mary University of London, London, UK
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50
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Salas Ballestín A, Frontera Juan G, Sharluyan Petrosyan A, Chocano González E, Figuerola Mulet J, De Carlos Vicente JC. Drowning Accidents in a Spanish Pediatric Intensive Care Unit: An Observational Study for 29 Years. Pediatr Emerg Care 2022; 38:e1631-e1636. [PMID: 36173436 DOI: 10.1097/pec.0000000000002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Drowning is one of the most frequent accidents in children. We aimed to describe demographic and epidemiological characteristics of drowned children who required admission to a pediatric intensive care unit (PICU) to identify risk factors to guide possible preventive measures to avoid severe drowning. METHODS We conducted an observational study for 29 years (retrospective between 1991 and 2004; prospective between 2005 and 2019) that included all children (0-15 years old) requiring PICU admission after drowning. Data regarding patient characteristics, accident circumstances, and neurological outcomes at PICU discharge were analyzed. RESULTS A total of 160 patients were included, with no significant decrease over the study period. There was a predominance of males (75%), young age (60%; 1-5 years), summer months (91.1%; May-September), tourists (14.12 [95% confidence interval, 9.2-21.7] times higher risk of drowning than residents), swimming pool accidents (88.8%), and inadequate supervision (77.9%). The mortality was 18.7%, and 7.5% of admitted children had severe neurological sequelae. The initial resuscitation maneuvers by accident witnesses were incorrect in nearly half of the patients in whom these could be analyzed. CONCLUSIONS Emphasis should be placed on implementing preventive measures, focused on the described risk groups, and insisting on adequate supervision, swimming training programs, and training of the general population in safe rescue and cardiopulmonary resuscitation.
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