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Aufderheide TP, Kalra R, Kosmopoulos M, Bartos JA, Yannopoulos D. Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death. Ann N Y Acad Sci 2022; 1507:37-48. [PMID: 33609316 PMCID: PMC8377067 DOI: 10.1111/nyas.14580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/03/2023]
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging method of cardiopulmonary resuscitation to improve outcomes from cardiac arrest. This approach targets patients with out-of-hospital cardiac arrest previously unresponsive and refractory to standard treatment, combining approximately 1 h of standard CPR followed by venoarterial extracorporeal membrane oxygenation (VA-ECMO) and coronary artery revascularization. Despite its relatively new emergence for the treatment of cardiac arrest, the approach is grounded in a vast body of preclinical and clinical data that demonstrate significantly improved survival and neurological outcomes despite unprecedented, prolonged periods of CPR. In this review, we detail the principles behind VA-ECMO-facilitated resuscitation, contemporary clinical approaches with outcomes, and address the emerging new understanding of the process of death and capability for neurological recovery.
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Affiliation(s)
- Tom P. Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rajat Kalra
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN,Cardiovascular Division, University of Minnesota, Minneapolis, MN
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Jason A. Bartos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN,Cardiovascular Division, University of Minnesota, Minneapolis, MN
| | - Demetris Yannopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN,Cardiovascular Division, University of Minnesota, Minneapolis, MN
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Kosmopoulos M, Bartos JA, Yannopoulos D. ST-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest. Interv Cardiol Clin 2021; 10:359-368. [PMID: 34053622 DOI: 10.1016/j.iccl.2021.03.007] [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: 11/26/2022]
Abstract
5-10% of ST-elevated myocardial infarctions (STEMI) present with out-of-hospital cardiac arrest (OHCA). Although this subgroup of patients carries the highest in-hospital mortality among the STEMI population, it is the least likely to undergo coronary angiography and revascularization. Due to the concomitant neurologic injury, patients with OHCA STEMI require prolonged hospitalization and adjustments to standard MI management. This review systematically assesses the course of patients with OHCA STEMI from development of the arrest to hospital discharge, assesses the limiting factors for their treatment access, and presents the evidence-based optimal intervention strategy for this high-risk MI population.
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Affiliation(s)
- Marinos Kosmopoulos
- Cardiovascular Division, Center for Resuscitation Medicine, University of Minnesota Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Jason A Bartos
- Cardiovascular Division, Center for Resuscitation Medicine, University of Minnesota Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Demetris Yannopoulos
- Cardiovascular Division, Center for Resuscitation Medicine, University of Minnesota Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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Abstract
The signal acquired in vivo using a diffusion-weighted MR imaging (DWI) sequence is influenced by blood motion in the tissue. This means that perfusion information from a DWI sequence can be obtained in addition to thermal diffusion, if the appropriate sequence parameters and postprocessing methods are applied. This is commonly regrouped under the denomination intravoxel incoherent motion (IVIM) perfusion MR imaging. Of relevance, the perfusion information acquired with IVIM is essentially local, quantitative and acquired without intravenous injection of contrast media. The aim of this work is to review the IVIM method and its clinical applications.
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Affiliation(s)
- Christian Federau
- University and ETH Zürich, Institute for Biomedical Engineering, Gloriastrasse 35, Zürich 8092, Switzerland; Ai Medical AG, Goldhaldenstr 22a, Zollikon 8702, Switzerland.
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Brett BL, Koch KM, Muftuler LT, Budde M, McCrea MA, Meier TB. Association of Head Impact Exposure with White Matter Macrostructure and Microstructure Metrics. J Neurotrauma 2021; 38:474-484. [PMID: 33003979 PMCID: PMC7875606 DOI: 10.1089/neu.2020.7376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Prior studies have reported white matter abnormalities associated with a history of cumulative concussion and/or repetitive head impacts (RHI) in contact sport athletes. Growing evidence suggests these abnormalities may begin as more subtle changes earlier in life in active younger athletes. We investigated the relationship between prior concussion and contact sport exposure with multi-modal white matter microstructure and macrostructure using magnetic resonance imaging. High school and collegiate athletes (n = 121) completed up to four evaluations involving neuroimaging. Linear mixed-effects models examined associations of years of contact sport exposure (i.e., RHI proxy) and prior concussion across multiple metrics of white matter, including total white matter volume, diffusion tensor imaging (DTI) metrics, diffusion kurtosis imaging (DKI) metrics, and quantitative susceptibility mapping (QSM). A significant inverse association between cumulative years of contact sport exposure and QSM was observed, F(1, 237.77) = 4.67, p = 0.032. Cumulative contact sport exposure was also associated with decreased radial diffusivity, F(1, 114.56) = 5.81, p = 0.018, as well as elevated fractional anisotropy, F(1, 115.32) = 5.40, p = 0.022, and radial kurtosis, F(1, 113.45) = 4.03, p = 0.047. In contrast, macroscopic white matter volume was not significantly associated with cumulative contact sport exposure (p > 0.05). Concussion history was not significantly associated with QSM, DTI, DKI, or white matter volume (all, p > 0.05). Cumulative contact sport exposure is associated with subtle differences in white matter microstructure, but not gross white matter macrostructure, in young active athletes. Longitudinal follow-up is required to assess the progression of these findings to determine their contribution to potential adverse effects later in life.
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Affiliation(s)
- Benjamin L. Brett
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin M. Koch
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Depertment of Radiology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Imaging Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - L. Tugan Muftuler
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Depertment of Radiology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Budde
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy B. Meier
- Department of Neurosurgery, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for Neurotrauma Research, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Biomedical Engineering, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Diagnostic accuracy of a revised computed tomography angiography score for brain death confirmation, combining supra-tentorial arteries and infra-tentorial veins. Eur J Radiol 2020; 130:109132. [PMID: 32619753 DOI: 10.1016/j.ejrad.2020.109132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/08/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The 4-point score is the corner stone of brain death (BD) confirmation using computed tomography angiography (CTA). We hypothesized that considering the superior petrosal veins (SPVs) may improve CTA diagnosis performance in BD setting. We aimed at comparing the diagnosis performance of three revised CTA scores including SPVs and the 4-point score in the confirmation of BD. METHODS In this retrospective study, 69 consecutive adult-patients admitted in a French University Hospital meeting clinical brain death criteria and receiving at least one CTA were included. CTA images were reviewed by two blinded neuroradiologists. A first analysis compared the 4-point score, considered as the reference and three non-opacification scores: a "Toulouse score" including SPVs and middle cerebral arteries, a "venous score" including SPVs and internal cerebral veins and a "7-score" including all these vessels and the basilar artery. Psychometric tools, observer agreement and misclassification rates were assessed. A second analysis considered clinical examination as the reference. RESULTS Brain death was confirmed by the 4-score in 59 cases (89.4 %). When compared to the 4-score, the Toulouse score displayed a 100 % positive predictive value, a substantial observer agreement (0.77 [0.53; 1]) and the least misclassification rate (3.03 %). Results were similar in the craniectomy subgroup. The Toulouse score was the only revised test that combined a sensitivity close to that of the 4-score (86.4 % [75.7; 93.6] and 89.4 % [79.4; 95.6], p-value < 0.001, respectively) and a substantial observer agreement. CONCLUSIONS A score including SPVs and middle cerebral arteries is a valid method for BD confirmation using CTA even in patients receiving craniectomy.
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