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El-Menyar A, Wahlen BM. Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit. World J Cardiol 2024; 16:126-136. [PMID: 38576519 PMCID: PMC10989225 DOI: 10.4330/wjc.v16.i3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
The post-resuscitation period is recognized as the main predictor of cardiopulmonary resuscitation (CPR) outcomes. The first description of post-resuscitation syndrome and stony heart was published over 50 years ago. Major manifestations may include but are not limited to, persistent precipitating pathology, systemic ischemia/reperfusion response, post-cardiac arrest brain injury, and finally, post-cardiac arrest myocardial dysfunction (PAMD) after successful resuscitation. Why do some patients initially survive successful resuscitation, and others do not? Also, why does the myocardium response vary after resuscitation? These questions have kept scientists busy for several decades since the first successful resuscitation was described. By modifying the conventional modalities of resuscitation together with new promising agents, rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal, stony heart. Community awareness and staff education are crucial for shortening the resuscitation time and improving short- and long-term outcomes. Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes. This review extensively addresses the underlying pathophysiology, management, and outcomes of post-resuscitation syndrome. The pattern, management, and outcome of PAMD and post-cardiac arrest shock are different based on many factors, including in-hospital cardiac arrest vs out-of-hospital cardiac arrest (OHCA), witnessed vs unwitnessed cardiac arrest, the underlying cause of arrest, the duration, and protocol used for CPR. Although restoring spontaneous circulation is a vital sign, it should not be the end of the game or lone primary outcome; it calls for better understanding and aggressive multi-disciplinary interventions and care. The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.
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Affiliation(s)
- Ayman El-Menyar
- Department of Trauma and Vascular Surgery, Clinical Research, Hamad Medical Corporation, Doha 3050, Qatar
- Department of Clinical Medicine, Weill Cornell Medical College, Doha 24144, Qatar.
| | - Bianca M Wahlen
- Department of Anesthesiology, Hamad Medical Corporation, Doha 3050, Qatar
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Javaudin F, Bougouin W, Fanet L, Diehl JL, Jost D, Beganton F, Empana JP, Jouven X, Adnet F, Lamhaut L, Lascarrou JB, Cariou A, Dumas F. Cumulative dose of epinephrine and mode of death after non-shockable out-of-hospital cardiac arrest: a registry-based study. Crit Care 2023; 27:496. [PMID: 38124126 PMCID: PMC10734153 DOI: 10.1186/s13054-023-04776-0] [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: 10/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Epinephrine increases the chances of return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA), especially when the initial rhythm is non-shockable. However, this drug could also worsen the post-resuscitation syndrome (PRS). We assessed the association between epinephrine use during cardiopulmonary resuscitation (CPR) and subsequent intensive care unit (ICU) mortality in patients with ROSC after non-shockable OHCA. METHODS We used data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (capturing OHCA data located in the Greater Paris area, France) between May 2011 and December 2021. All adults with ROSC after medical, cardiac and non-cardiac causes, non-shockable OHCA admitted to an ICU were included. The mode of death in the ICU was categorized as cardiocirculatory, neurological, or other. RESULTS Of the 2,792 patients analyzed, there were 242 (8.7%) survivors at hospital discharge, 1,004 (35.9%) deaths from cardiocirculatory causes, 1,233 (44.2%) deaths from neurological causes, and 313 (11.2%) deaths from other etiologies. The cardiocirculatory death group received more epinephrine (4.6 ± 3.8 mg versus 1.7 ± 2.8 mg, 3.2 ± 2.6 mg, and 3.5 ± 3.6 mg for survivors, neurological deaths, and other deaths, respectively; p < 0.001). The proportion of cardiocirculatory death increased linearly (R2 = 0.92, p < 0.001) with cumulative epinephrine doses during CPR (17.7% in subjects who did not receive epinephrine and 62.5% in those who received > 10 mg). In multivariable analysis, a cumulative dose of epinephrine was strongly associated with cardiocirculatory death (adjusted odds ratio of 3.45, 95% CI [2.01-5.92] for 1 mg of epinephrine; 12.28, 95% CI [7.52-20.06] for 2-5 mg; and 23.71, 95% CI [11.02-50.97] for > 5 mg; reference 0 mg; population reference: alive at hospital discharge), even after adjustment on duration of resuscitation. The other modes of death (neurological and other causes) were also associated with epinephrine use, but to a lesser extent. CONCLUSIONS In non-shockable OHCA with ROSC, the dose of epinephrine used during CPR is strongly associated with early cardiocirculatory death. Further clinical studies aimed at limiting the dose of epinephrine during CPR seem warranted. Moreover, strategies for the prevention and management of PRS should take this dose of epinephrine into consideration for future trials.
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Affiliation(s)
- François Javaudin
- Paris Sudden Death Expertise Center, 75015, Paris, France.
- Emergency Department, Nantes University Hospital, 44000, Nantes, France.
- SAMU, 1 Quai Moncousu, 44093, Nantes Cedex1, France.
| | - Wulfran Bougouin
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300, Massy, France
- AfterROSC Network, Paris, France
| | - Lucie Fanet
- Paris Sudden Death Expertise Center, 75015, Paris, France
| | - Jean-Luc Diehl
- Medical Intensive Care Unit, AP-HP, European Georges Pompidou Hospital, 75015, Paris, France
- Innovative Therapies in Hemostasis, INSERM 1140, Université Paris Cité, 75006, Paris, France
| | - Daniel Jost
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- BSPP (Paris Fire-Brigade Emergency-Medicine Department), 1 Place Jules Renard, 75017, Paris, France
| | - Frankie Beganton
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
| | - Jean-Philippe Empana
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
| | - Xavier Jouven
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- Cardiology Department, AP-HP, European Georges Pompidou Hospital, 75015, Paris, France
| | - Frédéric Adnet
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Lionel Lamhaut
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- SAMU de Paris, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Jean-Baptiste Lascarrou
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- AfterROSC Network, Paris, France
- Medecine Intensive Reanimation, Nantes University Hospital, 44000, Nantes, France
| | - Alain Cariou
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- AfterROSC Network, Paris, France
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, 75014, Paris, France
| | - Florence Dumas
- Paris Sudden Death Expertise Center, 75015, Paris, France
- Université Paris Cité, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, 75015, Paris, France
- Emergency Department, AP-HP, Cochin-Hotel-Dieu Hospital, 75014, Paris, France
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Justice CN, Zhu X, Li J, O'Donnell JM, Vanden Hoek TL. Intra-ischemic hypothermia cardioprotection involves modulation of PTEN/Akt/ERK signaling and fatty acid oxidation. Physiol Rep 2023; 11:e15611. [PMID: 36807889 PMCID: PMC9938006 DOI: 10.14814/phy2.15611] [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: 10/31/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/20/2023] Open
Abstract
Therapeutic hypothermia (TH) provides cardioprotection from ischemia/reperfusion (I/R) injury. However, it remains unknown how TH regulates metabolic recovery. We tested the hypothesis that TH modulates PTEN, Akt, and ERK1/2, and improves metabolic recovery through mitigation of fatty acid oxidation and taurine release. Left ventricular function was monitored continuously in isolated rat hearts subjected to 20 min of global, no-flow ischemia. Moderate cooling (30°C) was applied at the start of ischemia and hearts were rewarmed after 10 min of reperfusion. The effect of TH on protein phosphorylation and expression at 0 and 30 min of reperfusion was investigated by western blot analysis. Post-ischemic cardiac metabolism was investigated by 13 C-NMR. TH enhanced recovery of cardiac function, reduced taurine release, and enhanced PTEN phosphorylation and expression. Phosphorylation of Akt and ERK1/2 was increased at the end of ischemia but decreased at the end of reperfusion. On NMR analysis, TH-treated hearts displayed decreased fatty acid oxidation. Direct cardioprotection by moderate intra-ischemic TH is associated with decreased fatty acid oxidation, reduced taurine release, enhanced PTEN phosphorylation and expression, and enhanced activation of both Akt and ERK1/2 prior to reperfusion.
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Affiliation(s)
- Cody N. Justice
- Center for Advanced Resuscitation Medicine, Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA,Department of Physiology and BiophysicsUniversity of Illinois at ChicagoChicagoIllinoisUSA,Center for Cardiovascular ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Xiangdong Zhu
- Center for Advanced Resuscitation Medicine, Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA,Center for Cardiovascular ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Jing Li
- Center for Advanced Resuscitation Medicine, Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA,Center for Cardiovascular ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - J. Michael O'Donnell
- Department of Physiology and BiophysicsUniversity of Illinois at ChicagoChicagoIllinoisUSA,Center for Cardiovascular ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Terry L. Vanden Hoek
- Center for Advanced Resuscitation Medicine, Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA,Department of Physiology and BiophysicsUniversity of Illinois at ChicagoChicagoIllinoisUSA,Center for Cardiovascular ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Magagnoli I, Romito G, Troia R, Murgia E, Giunti M. Reversible myocardial dysfunction in a dog after resuscitation from cardiopulmonary arrest. J Vet Cardiol 2021; 34:1-7. [DOI: 10.1016/j.jvc.2020.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 11/29/2020] [Accepted: 12/14/2020] [Indexed: 01/28/2023]
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He Y, Wang G, Li C, Wang Y, Zhang Q. The protective effects of phosphodiesterase-5 inhibitor, sildenafil on post-resuscitation cardiac dysfunction of cardiac arrest: by regulating the miR-155-5p and miR-145-5p. Scand J Trauma Resusc Emerg Med 2021; 29:2. [PMID: 33407761 PMCID: PMC7787123 DOI: 10.1186/s13049-020-00819-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background MiRNA-155 and miRNA-145 have been demonstrated to function as a key regulator in the development of the cardiovascular system. Recent experimental and clinical studies have indicated the cardioprotective role of sildenafil during ischemia/reperfusion (I/R) injury. This study was designed to investigate if administration of sildenafil will attenuate post-resuscitation myocardial dysfunction by regulating miRNA-155 and miR-145 expressions. Methods Thirty-two male pigs (weighing 30 ± 2 kg) were randomly divided into 4 groups, sildenafil group (n = 8), sildenafil +NG-nitro-l-arginine methyl ester (L-NAME) (20 mg/kg L) group (n = 8), saline (SA group, n = 8); and sham operation group (sham group, n = 8). Eight minutes of untreated VF was followed by defibrillation in anesthetized, closed-chest pigs. Hemodynamic status and blood samples were obtained at 0 min, 0.5, 1, 2, 4 and 6 h after return of spontaneous circulation (ROSC), and the hearts were removed and analyzed under electron microscopy, quantitative real-time polymerase chain reaction and ultra structural analysis were performed to evaluate myocardial injury. Results Compared with the sildenafil + L-NAME and saline groups, the sildenafil group had better outcomes in terms of hemodynamic and oxygen metabolism parameters as well as 24-h survival rate, and attenuated myocardial injury; In this study, CA pigs showed evidently increased levels of miR-155-5p and miR-145-5p, while the sildenafil treatment decreased the levels of miR-155-5p and miR-145-5p in CA pigs. In addition, the levels of eNOS was decreased in CA pigs, validating sildenafil attenuating post-resuscitation myocardial dysfunction by regulating miRNA-155 and miR-145 expressions. Conclusions Sildenafil group had better outcomes in terms of hemodynamic and oxygen metabolism parameters as well as 24-h survival rate, inhibited the increases in the miR-155-5p and miR-145-5p levels and attenuated myocardial injury in a porcine model of CA and resuscitation. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-020-00819-5.
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Affiliation(s)
- Yong He
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guoxing Wang
- Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chuang Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuxing Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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6
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Jozwiak M, Bougouin W, Geri G, Grimaldi D, Cariou A. Post-resuscitation shock: recent advances in pathophysiology and treatment. Ann Intensive Care 2020; 10:170. [PMID: 33315152 PMCID: PMC7734609 DOI: 10.1186/s13613-020-00788-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022] Open
Abstract
A post-resuscitation shock occurs in 50–70% of patients who had a cardiac arrest. It is an early and transient complication of the post-resuscitation phase, which frequently leads to multiple-organ failure and high mortality. The pathophysiology of post-resuscitation shock is complex and results from the whole-body ischemia–reperfusion process provoked by the sequence of circulatory arrest, resuscitation manoeuvers and return of spontaneous circulation, combining a myocardial dysfunction and sepsis features, such as vasoplegia, hypovolemia and endothelial dysfunction. Similarly to septic shock, the hemodynamic management of post-resuscitation shock is based on an early and aggressive hemodynamic management, including fluid administration, vasopressors and/or inotropes. Norepinephrine should be considered as the first-line vasopressor in order to avoid arrhythmogenic effects of other catecholamines and dobutamine is the most established inotrope in this situation. Importantly, the optimal mean arterial pressure target during the post-resuscitation shock still remains unknown and may probably vary according to patients. Mechanical circulatory support by extracorporeal membrane oxygenation can be necessary in the most severe patients, when the neurological prognosis is assumed to be favourable. Other symptomatic treatments include protective lung ventilation with a target of normoxia and normocapnia and targeted temperature management by avoiding the lowest temperature targets. Early coronary angiogram and coronary reperfusion must be considered in ST-elevation myocardial infarction (STEMI) patients with preserved neurological prognosis although the timing of coronary angiogram in non-STEMI patients is still a matter of debate. Further clinical research is needed in order to explore new therapeutic opportunities regarding inflammatory, hormonal and vascular dysfunction.
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Affiliation(s)
- Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris-Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27, rue du faubourg Saint Jacques, 75014, Paris, France. .,Université de Paris, Paris, France.
| | - Wulfran Bougouin
- Service de Médecine Intensive Réanimation, Hôpital Privé Jacques Cartier, Ramsay Générale de Santé, Massy, France.,INSERM U970, Paris-Cardiovascular-Research-Center, Paris, France.,Paris Sudden-Death-Expertise-Centre, Paris, France.,AfterROSC Network Group, Paris, France
| | - Guillaume Geri
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.,Université Paris-Saclay, Paris, France.,INSERM UMR1018, Centre de Recherche en Epidémiologie Et Santé Des Populations, Villejuif, France.,AfterROSC Network Group, Paris, France
| | - David Grimaldi
- Service de Soins Intensifs CUB-Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.,AfterROSC Network Group, Paris, France
| | - Alain Cariou
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris-Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27, rue du faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France.,INSERM U970, Paris-Cardiovascular-Research-Center, Paris, France.,Paris Sudden-Death-Expertise-Centre, Paris, France.,AfterROSC Network Group, Paris, France
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Abstract
Cardiac arrest (CA) results in multiorgan ischemia until return of spontaneous circulation and often is followed by a low-flow shock state. Upon restoration of circulation and organ perfusion, resuscitative teams must act quickly to achieve clinical stability while simultaneously addressing the underlying etiology of the initial event. Optimal cardiovascular care demands focused management of the post-cardiac arrest syndrome and associated shock. Acute coronary syndrome should be considered and managed in a timely manner, because early revascularization improves patient outcomes and may suppress refractory arrhythmias. This review outlines the diagnostic and therapeutic considerations that define optimal cardiovascular care after CA.
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Affiliation(s)
- Barry Burstein
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jacob C Jentzer
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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8
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Elfwén L, Lagedal R, Rubertsson S, James S, Oldgren J, Olsson J, Hollenberg J, Jensen U, Ringh M, Svensson L, Nordberg P. Post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest patients randomized to immediate coronary angiography versus standard of care. IJC HEART & VASCULATURE 2020; 27:100483. [PMID: 32154359 PMCID: PMC7056719 DOI: 10.1016/j.ijcha.2020.100483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Abstract
Background Immediate coronary angiography with subsequent percutaneous coronary intervention (PCI) has the potential to reduce post-resuscitation myocardial dysfunction in out-of-hospital cardiac arrest (OHCA) patients. The aim of this study was to see if immediate coronary angiography, with potential PCI, in patients without ST-elevation on the ECG, influenced post-resuscitation myocardial function and cardiac biomarkers. Methods A secondary analysis of the Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest (DISCO) trial (ClinicalTrials.gov ID: NCT02309151). Patients with bystander-witnessed OHCA, without ST-elevations on the ECG were randomly assigned to immediate coronary angiography within two hours of cardiac arrest (n = 38) versus standard-of-care with deferred angiography (n = 40). Outcome measures included left ventricle ejection fraction (LVEF) at 24 h, peak Troponin T levels, lactate clearance and NT-proBNP at 72 h. Results In the immediate-angiography group, median LVEF at 24 h was 47% (Q1-Q3; 30–55) vs. 46% (Q1-Q3; 35–55) in the standard-of-care group. Peak Troponin-T levels during the first 24 h were 362 ng/L (Q1-Q3; 174–2020) in the immediate angiography group and 377 ng/L (Q1-Q3; 205–1078) in the standard-of-care group. NT-proBNP levels at 72 h were 931 ng/L (Q1-Q3; 396–2845) in the immediate-angiography group and 1913 ng/L (Q1-Q3; 489–3140) in the standard-of-care group. Conclusion In this analysis of OHCA patients without ST-elevation on the ECG randomized to immediate coronary angiography or standard-of-care, no differences in post-resuscitation myocardial dysfunction parameters between the two groups were found. This finding was consistent also in patients randomized to immediate coronary angiography where PCI was performed compared to those where PCI was not performed.
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Affiliation(s)
- Ludvig Elfwén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden
| | - Rickard Lagedal
- Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Sten Rubertsson
- Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Stefan James
- Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Sweden
| | - Jonas Oldgren
- Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology, Uppsala University, Sweden
| | - Jens Olsson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden
| | - Jacob Hollenberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Ulf Jensen
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sweden
| | - Mattias Ringh
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Leif Svensson
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
| | - Per Nordberg
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna, Sweden
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Topjian AA, de Caen A, Wainwright MS, Abella BS, Abend NS, Atkins DL, Bembea MM, Fink EL, Guerguerian AM, Haskell SE, Kilgannon JH, Lasa JJ, Hazinski MF. Pediatric Post–Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e194-e233. [DOI: 10.1161/cir.0000000000000697] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Successful resuscitation from cardiac arrest results in a post–cardiac arrest syndrome, which can evolve in the days to weeks after return of sustained circulation. The components of post–cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Pediatric post–cardiac arrest care focuses on anticipating, identifying, and treating this complex physiology to improve survival and neurological outcomes. This scientific statement on post–cardiac arrest care is the result of a consensus process that included pediatric and adult emergency medicine, critical care, cardiac critical care, cardiology, neurology, and nursing specialists who analyzed the past 20 years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. The statement summarizes the epidemiology, pathophysiology, management, and prognostication after return of sustained circulation after cardiac arrest, and it provides consensus on the current evidence supporting elements of pediatric post–cardiac arrest care.
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10
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Geri G, Grimaldi D, Seguin T, Lamhaut L, Marin N, Chiche JD, Pène F, Bouglé A, Daviaud F, Morichau-Beauchant T, Arnaout M, Champigneulle B, Zafrani L, Bourcier S, Nguyen YL, Charpentier J, Mira JP, Coste J, Vinsonneau C, Cariou A. Hemodynamic efficiency of hemodialysis treatment with high cut-off membrane during the early period of post-resuscitation shock: The HYPERDIA trial. Resuscitation 2019; 140:170-177. [PMID: 30974188 DOI: 10.1016/j.resuscitation.2019.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/15/2019] [Accepted: 03/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND After resuscitation of cardiac arrest (CA), an acute circulatory failure occurs in about 50% of cases, which shares many characteristics with septic shock. Most frequently, supportive treatments are poorly efficient to prevent multiple organ failure and death. We evaluated whether an early plasma removal of inflammatory mediators using high cut-off continuous veno-venous hemodialysis (HCO-CVVHD) could improve hemodynamic status and outcome of these patients. PATIENTS AND METHODS We performed a randomized open-label trial. Patients with post-cardiac arrest shock (defined as requirement of norepinephrine or epinephrine infusion > 1 mg/h) were included. The experimental group received 2 distinct sessions of HCO-CVVHD during the first 48 h following ICU admission. The control group received continuous veno-venous hemofiltration (CVVH) with standard membranes if needed. The primary endpoint was the delay to shock resolution asssessed by the length of catecholamine infusion. Number of vasopressors-free days at day 28, arterial blood pressure measures every 6-hours, daily fluid balance and mortality (ICU and day-28) were evaluated as secondary endpoints. RESULTS 35 patients were included: 17 (median age 68.4, 59% male) in the HCO-CVVHD group and 18 (median age 66.3, 83% male) in the control group. Baseline characteristics did not differ between the two groups. Day-28 mortality rate was 64.7% and 72.2% in the HCO-CVVHD and control group, respectively (p = 0.72). Probability of vasopressors discontinuation over time was similar in the two groups (p for logrank test = 0.67). Number of day-28 catecholamine-free days was 25.1 [0, 26.5] and 24.5 [0, 26.2] in the HCO-CVVHD and control group, respectively (p = 0.65). No difference was observed regarding the daily-dose of vasopressors, arterial pressure profile and fluid balance. CONCLUSION In cardiac arrest patients, HCO-CVVHD did not decrease the lenght of post-resuscitation shock and had no significant effect on hemodynamic profile. REGISTRATION NCT00780299.
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Affiliation(s)
- Guillaume Geri
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - David Grimaldi
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Thierry Seguin
- Medical-surgical Intensive Care Unit, Toulouse-Rangueil Hospital, Toulouse, France
| | - Lionel Lamhaut
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France; SAMU 75, Necker University Hospital, APHP, Paris, France
| | - Nathalie Marin
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Jean-Daniel Chiche
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Adrien Bouglé
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Fabrice Daviaud
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | | | - Michel Arnaout
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | | | - Lara Zafrani
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Simon Bourcier
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Yen-Lan Nguyen
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Julien Charpentier
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Joël Coste
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Biostatistics and Epidemiology Unit, Hôtel Dieu, APHP, Paris, France
| | | | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital, APHP, Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Sudden Death Expertise Centre, INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France.
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11
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Yao Y, Johnson NJ, Perman SM, Ramjee V, Grossestreuer AV, Gaieski DF. Myocardial dysfunction after out-of-hospital cardiac arrest: predictors and prognostic implications. Intern Emerg Med 2018; 13:765-772. [PMID: 28983759 PMCID: PMC5967989 DOI: 10.1007/s11739-017-1756-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/21/2017] [Indexed: 12/14/2022]
Abstract
We aim to determine the incidence of early myocardial dysfunction after out-of-hospital cardiac arrest, risk factors associated with its development, and association with outcome. A retrospective chart review was performed among consecutive out-of-hospital cardiac arrest (OHCA) patients who underwent echocardiography within 24 h of return of spontaneous circulation at three urban teaching hospitals. Our primary outcome is early myocardial dysfunction, defined as a left ventricular ejection fraction < 40% on initial echocardiogram. We also determine risk factors associated with myocardial dysfunction using multivariate analysis, and examine its association with survival and neurologic outcome. A total of 190 patients achieved ROSC and underwent echocardiography within 24 h. Of these, 83 (44%) patients had myocardial dysfunction. A total of 37 (45%) patients with myocardial dysfunction survived to discharge, 39% with intact neurologic status. History of congestive heart failure (OR 6.21; 95% CI 2.54-15.19), male gender (OR 2.27; 95% CI 1.08-4.78), witnessed arrest (OR 4.20; 95% CI 1.78-9.93), more than three doses of epinephrine (OR 6.10; 95% CI 1.12-33.14), more than four defibrillations (OR 4.7; 95% CI 1.35-16.43), longer duration of resuscitation (OR 1.06; 95% CI 1.01-1.10), and therapeutic hypothermia (OR 3.93; 95% CI 1.32-11.75) were associated with myocardial dysfunction. Cardiopulmonary resuscitation immediately initiated by healthcare personnel was associated with lower odds of myocardial dysfunction (OR 0.40; 95% CI 0.17-0.97). There was no association between early myocardial dysfunction and mortality or neurological outcome. Nearly half of OHCA patients have myocardial dysfunction. A number of clinical factors are associated with myocardial dysfunction, and may aid providers in anticipating which patients need early diagnostic evaluation and specific treatments. Early myocardial dysfunction is not associated with neurologically intact survival.
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Affiliation(s)
- Yuan Yao
- Grand Strand Health, Myrtle Beach, USA
| | - Nicholas James Johnson
- Department of Emergency Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359702, Seattle, WA, 98104, USA.
| | | | - Vimal Ramjee
- The Chattanooga Heart Institute, Chattanooga, USA
| | | | - David Foster Gaieski
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
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12
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Zhou H, Huang J, Zhu L, Cao Y. Erythropoietin alleviates post-resuscitation myocardial dysfunction in rats potentially through increasing the expression of angiotensin II receptor type 2 in myocardial tissues. Mol Med Rep 2018; 17:5184-5192. [PMID: 29393490 PMCID: PMC5865983 DOI: 10.3892/mmr.2018.8473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023] Open
Abstract
Activation of renin-angiotensin system (RAS) is one of the pathological mechanisms associated with myocardial ischemia-reperfusion injury following resuscitation. The present study aimed to determine whether erythropoietin (EPO) improves post‑resuscitation myocardial dysfunction and how it affects the renin‑angiotensin system. Sprague‑Dawley rats were randomly divided into sham, vehicle, epinephrine (EP), EPO and EP + EPO groups. Excluding the sham group, all groups underwent cardiopulmonary resuscitation (CPR) 4 min after asphyxia‑induced cardiac arrest (CA). EP and/or EPO was administrated by intravenous injection when CPR began. The results demonstrated that the vehicle group exhibited lower mean arterial pressure, left ventricular systolic pressure, maximal ascending rate of left ventricular pressure during left ventricular isovolumic contraction and maximal descending rate of left ventricular pressure during left ventricular isovolumic relaxation (+LVdP/dt max and ‑LVdP/dt max, respectively), and higher left ventricular end‑diastolic pressure, compared with the sham group following return of spontaneous circulation (ROSC). Few significant differences were observed concerning the myocardial function between the vehicle and EP groups; however, compared with the vehicle group, EPO reversed myocardial function indices following ROSC, excluding‑LVdP/dt max. Serum renin and angiotensin (Ang) II levels were measured by ELISA. The serum levels of renin and Ang II were significantly increased in the vehicle group compared with the sham group, which was also observed for the myocardial expression of renin and Ang II receptor type 1 (AT1R), as determined by reverse transcription‑quantitative polymerase chain reaction and western blotting. EPO alone did not significantly reduce the high serum levels of renin and Ang II post-resuscitation, but changed the protein levels of renin and AT1R expression in myocardial tissues. However, EPO enhanced the myocardial expression of Ang II receptor type 2 (AT2R) following ROSC. In conclusion, the present study confirmed that CA resuscitation activated the renin‑Ang II‑AT1R signaling pathway, which may contribute to myocardial dysfunction in rats. The present study confirmed that EPO treatment is beneficial for protecting cardiac function post‑resuscitation, and the roles of EPO in alleviating post‑resuscitation myocardial dysfunction may potentially be associated with enhanced myocardial expression of AT2R.
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Affiliation(s)
- Hourong Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jia Huang
- Emergency Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou 550002, P.R. China
| | - Li Zhu
- Institute of Anesthesia, Guizhou Medical University, Guiyang, Guizhou 550002, P.R. China
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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13
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Arrêt cardiaque du nourrisson et de l’enfant. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Bougouin W, Aissaoui N, Combes A, Deye N, Lamhaut L, Jost D, Maupain C, Beganton F, Bouglé A, Karam N, Dumas F, Marijon E, Jouven X, Cariou A. Post-cardiac arrest shock treated with veno-arterial extracorporeal membrane oxygenation: An observational study and propensity-score analysis. Resuscitation 2016; 110:126-132. [PMID: 27865776 DOI: 10.1016/j.resuscitation.2016.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock. METHODS Using a large regional registry, we focused on all CA admitted in ICU. Among those who developed a post-CA shock, prognostic was compared according to VA-ECMO use, using logistic regression and propensity score. Specific prognostic factors were identified among VA-ECMO patients. RESULTS Among 2988 patients admitted after CA, 1489 developed a post-CA shock, and were included. They were mostly male (68%), with mean age 63 years (SD=15). Fiflty-two patients (3.5%) were treated with VA-ECMO, mostly patients with ischemic cause of CA (67%). Among patients with post-CA shock, 312 (21%) were discharged alive (25% in VA-ECMO group, 21% in control group, P=0.45). After adjustment for pre-hospital and in-hospital factors, survival did not differ among patients treated with VA-ECMO (OR for survival=0.9, 95%CI 0.4-2.3, P=0.84). After propensity-score matching, results were consistent. Among patients treated with VA-ECMO, initial arterial pH (OR=1.7 per 0.1 increase, 95%CI 1.0-2.8, P=0.04) and implantation of VA-ECMO over 24h after ROSC (OR=20.0, 95%CI 1.4-277.3, P=0.03) were associated with survival. CONCLUSIONS Post-CA shock is frequent and is associated with a high mortality rate. When used in selected patients, we observed that VA-ECMO could be an appropriate treatment.
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Affiliation(s)
- Wulfran Bougouin
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Nadia Aissaoui
- Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Medical ICU, Pompidou Hospital, APHP, Paris, France
| | - Alain Combes
- Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Pitié-Salpétrière Hospital, APHP, Paris, France
| | - Nicolas Deye
- Medical ICU, Lariboisière Hospital, AP-HP, Paris, France; INSERM U942, Paris, France
| | - Lionel Lamhaut
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; ICU and SAMU 75, Necker Enfants-Malades Hospital, Paris, France
| | - Daniel Jost
- Paris Sudden-Death-Expertise-Center, Paris, France; Paris Fire Brigade Emergency Dept., Paris, France
| | - Carole Maupain
- Cardiology Department, Pitié-Salpétrière Hospital, APHP, Paris, France
| | - Frankie Beganton
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Adrien Bouglé
- Human Histopathology and Animal Models Unit, Infection and Epidemiology Department, Institut Pasteur, Paris, France; Anesthesiology and Intensive Care, Institut de Cardiologie, Pitié-Salpétrière Hospital, Paris, France
| | - Nicole Karam
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Florence Dumas
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, Paris, France
| | - Eloi Marijon
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Xavier Jouven
- Cardiology Department, Pompidou Hospital, APHP, Paris, France; Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France
| | - Alain Cariou
- Paris-Cardiovascular-Research-Center, INSERM U970, Paris, France; Université Paris-Descartes-Sorbonne-Paris-Cité, Paris, France; Paris Sudden-Death-Expertise-Center, Paris, France; Medical ICU, Cochin Hospital, AP-HP, Paris, France.
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15
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Should we "block" refractory ventricular fibrillation? Resuscitation 2016; 107:A9-A10. [PMID: 27591055 DOI: 10.1016/j.resuscitation.2016.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
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16
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Urbano J, López J, González R, Fernández SN, Solana MJ, Toledo B, Carrillo Á, López-Herce J. Comparison between pressure-recording analytical method (PRAM) and femoral arterial thermodilution method (FATD) cardiac output monitoring in an infant animal model of cardiac arrest. Intensive Care Med Exp 2016; 4:13. [PMID: 27256288 PMCID: PMC4891310 DOI: 10.1186/s40635-016-0087-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/26/2016] [Indexed: 02/06/2023] Open
Abstract
Background The pressure-recording analytical method is a new semi-invasive method for cardiac output measurement (PRAM). There are no studies comparing this technique with femoral artery thermodilution (FATD) in an infant animal model. Methods A prospective study was performed using 25 immature Maryland pigs weighing 9.5 kg. Fifty-eight simultaneous measurements of cardiac index (CI) were made by FATD and PRAM at baseline and after return of spontaneous circulation. Differences, correlation, and concordance between both methods were analyzed. The ability of PRAM to track changes in CI was explored with a polar plot. Results Mean CI measurements were 4.5 L/min/m2 (95 % CI, 4.2–4.8 L/min/m2; coefficient of variation, 27 %) by FATD and 4.0 L/min/m2 (95 % CI, 3.6–4.3 L/min/m2; coefficient for variation, 37 %) by PRAM (difference, 0.5 L/min/m2; 95 % CI for the difference, 0.1–1.0 L/min/m2; p = 0.003; n = 58). No correlation between both methods was observed (r = 0.170, p = 0.20). Limits of agreement were −2.9 to 4.0 L/min/m2 (−69.9 to 84.9 %). Percentage error was 80.6 %. Only 26.1 % of data points lied within an absolute deviation of ±30° from the polar axis. Conclusions No correlation nor concordance between both methods was observed. Limits of agreement and percentage of error were high and clinically not acceptable. No concurrence between both methods in CI changes was observed. PRAM is not a useful method for measurement of the CI in this pediatric model of cardiac arrest.
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Affiliation(s)
- Javier Urbano
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Jorge López
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Rafael González
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Sarah N Fernández
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - María José Solana
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Blanca Toledo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Ángel Carrillo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense, Madrid, Spain.,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de investigación sanitaria del hospital Gregorio Marañón (IiSGM), Madrid, Spain. .,Universidad Complutense, Madrid, Spain. .,Research Network on Maternal and Child Health and Development II (REDSAMID II), Spanish Health Institute Carlos III, Madrid, Spain.
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17
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Geri G, Cariou A. Syndrome post-arrêt cardiaque. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 568] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Polderman KH, Varon J. Cool hemodynamics--the intricate interplay between therapeutic hypothermia and the post-cardiac arrest syndrome. Resuscitation 2015; 85:975-6. [PMID: 24998165 DOI: 10.1016/j.resuscitation.2014.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Kees H Polderman
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Joseph Varon
- Acute and Continuing Care, The University of Texas Health Science, Center at Houston, USA; The University of Texas Medical Branch at Galveston, University General Hospital, Houston, TX, USA
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Oksanen T, Skrifvars M, Wilkman E, Tierala I, Pettilä V, Varpula T. Postresuscitation hemodynamics during therapeutic hypothermia after out-of-hospital cardiac arrest with ventricular fibrillation: A retrospective study. Resuscitation 2014; 85:1018-24. [DOI: 10.1016/j.resuscitation.2014.04.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/18/2014] [Accepted: 04/27/2014] [Indexed: 10/25/2022]
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