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Zafar MA, Wu J, Vinholo TF, Li Y, Papanikolaou D, Ellauzi H, Ostberg NP, Kalyanasundaram A, Kalogerakos PD, Mukherjee SK, Ziganshin BA, Rizzo JA, Elefteriades JA. Bicuspid aortopathy does not require earlier surgical intervention. J Thorac Cardiovasc Surg 2024; 168:760-769.e4. [PMID: 37088130 DOI: 10.1016/j.jtcvs.2023.04.017] [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: 08/26/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Guidelines for surgical correction of patients with ascending thoracic aortic aneurysm (ATAA) with a bicuspid aortic valve (BAV) have oscillated over the years. In this study, we outline the natural history of the ascending aorta in patients with BAV and trileaflet aortic valve (TAV) ATAA followed over time, to ascertain if their behavior differs and to determine if a different threshold for intervention is required. METHODS Aortic diameters and long-term complications (ie, adverse aortic events) of 2428 patients (554 BAV and 1874 TAV) with ATAA before operative repair were reviewed. Growth rates, yearly complication rates, event-free survival, and risk of complications as a function of aortic size were calculated. Long-term follow-up and precise cause of death granularity was achieved via a comprehensive 6-pronged approach. RESULTS Aortic growth rate in patients with BAV vs TAV ATAA was 0.20 and 0.17 cm/year, respectively (P = .009), with the rate increasing with increasing aortic size. Yearly adverse aortic events rates increased with ATAA size and were lower for patients with BAV. The relative risk of adverse aortic events exhibited an exponential increase with aortic diameter. Patients with BAV had a lower all-cause and ascending aorta-specific adverse aortic events hazard. Age-adjusted 10-year event-free survival was significantly better for patients with BAV, and BAV emerged as a protective factor against type A dissection, rupture, and ascending aortic death. CONCLUSIONS The threshold for surgical repair of ascending aneurysm with BAV should not differ from that of TAV. Prophylactic surgery should be considered at 5.0 cm for patients with TAV (and BAV) at expert centers.
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Affiliation(s)
- Mohammad A Zafar
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Jinlin Wu
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Thais Faggion Vinholo
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Yupeng Li
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Political Sciences and Economics, Rowan University, Glassboro, NJ
| | - Dimitra Papanikolaou
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Hesham Ellauzi
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of General Surgery, Istishari Hospital, Amman, Jordan
| | - Nicolai P Ostberg
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Asanish Kalyanasundaram
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Paris D Kalogerakos
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Sandip K Mukherjee
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Bulat A Ziganshin
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - John A Rizzo
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Departments of Economics and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - John A Elefteriades
- Aortic Institute, Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
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2
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Tonna JE, Cho SM. Extracorporeal Cardiopulmonary Resuscitation. Crit Care Med 2024; 52:963-973. [PMID: 38224260 PMCID: PMC11098703 DOI: 10.1097/ccm.0000000000006185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
- Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - Sung-Min Cho
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
- Division of Neuroscience Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Neuroscience Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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3
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Roselli EE. Author Reply to Commentary: Don't miss the forest for the trees. J Thorac Cardiovasc Surg 2024; 167:2062. [PMID: 36610882 DOI: 10.1016/j.jtcvs.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart Vascular and Thoracic Institute, Cleveland, Ohio; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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4
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Shaeri S, Considine J, Dainty KN, Olasveengen TM, Morrison LJ. Accuracy of etiological classification of out-of-hospital cardiac arrest: A scoping review. Resuscitation 2024; 198:110199. [PMID: 38582438 DOI: 10.1016/j.resuscitation.2024.110199] [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: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The Utstein reporting template classifies the etiology of OHCA into "presumed cardiac" and "obvious non-cardiac" or "medical" and "non-medical" categories; however, the accuracy of these classifications is unclear. Ascertaining more accurately the etiology of OHCA is important to tailor advanced life support and identify etiologically consistent patient cohorts for reporting incidence and outcome and enrollment in clinical trials. This scoping review was proposed to identify the state of agreement on etiological classification based on emergency medical service (EMS) data using the Utstein format against other sources. METHOD We searched Medline, EBM-Cochrane, and Embase databases from 1946-2023 to identify studies that reported initial and confirmed etiologies of OHCA. A descriptive review of the included studies was conducted. RESULT The search yielded 22,994 citations. After excluding duplicates, 16,932 citations were reviewed for titles and abstracts. Twelve studies met the inclusion criteria of this review. The frequency of presumed cardiac etiologies based on EMS data was higher than confirmed cardiac etiologies (88% vs 33%) with 83-94% sensitivity and 73-76% specificity. In contrast, the frequency of presumed non-cardiac etiologies was lower than confirmed non-cardiac etiologies (3% vs 27%) with 52-74% sensitivity and 90-97.7% specificity estimated for respiratory disease. CONCLUSION Major disparities exist between current etiological classifications based on the Utstein reporting template and robust sources such as autopsy and medical records. Data linkage and validation are necessary to confirm the etiology of OHCA. Further research is needed on how this misclassification affects reported incidence and outcomes, and how contributing factors may improve etiological classifications.
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Affiliation(s)
- Sedigheh Shaeri
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health, Eastern Health, Box Hill, Australia
| | - Katie N Dainty
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Office of Research & Innovation, North York General Hospital, Toronto, Canada
| | - Theresa Mariero Olasveengen
- Department of Anesthesia and Intensive Care, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laurie J Morrison
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Canada; The Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
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Maigrot JLA, Vargo PR, Kramer B, Rigelsky C, Ghobrial J, Zahka K, Najm H, Roselli EE. Multifocal disease progression and subsequent intervention in patients with actin alpha-2 variants: A single-center experience. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01128-5. [PMID: 38065521 DOI: 10.1016/j.jtcvs.2023.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES To describe patient characteristics and indications for surgical intervention, reoperation, and outcomes in patients with actin alpha-2 (ACTA2) variants. METHODS A single-center retrospective cohort study with prospective follow-up was performed for 38 patients with an ACTA2 variant. RESULTS From 1999 to 2020, 26 (70%) patients underwent surgery; 11 remain under surveillance (mean follow-up, 7.5 ± 5 years). Median age at index operation was 42 (range, 10-69) years, with 4 pediatric cases. Thoracic aortic aneurysm was present in 19 (73%) patients (mean adult max diameter, 5.2 ± 0.8 cm; pediatric z score, 10.7 ± 5.4). Aortic dissection was present in 13 (50%) patients, with 4 (15%) having type A dissection. Operations included replacement of the aortic root in 16 (17%), ascending aorta in 20 (77%), and aortic arch in 14 (54%) patients. Four (15%) patients had coronary artery disease, and 2 (7.7%) underwent concomitant coronary artery bypass grafting. There was no operative mortality, stroke, reoperation for bleeding, or dialysis-dependent renal failure; One (3.8%) patient developed acute on chronic kidney injury. Three patients (12%) required prolonged ventilation. Eleven (42%) patients underwent 26 reoperations, median time 45 (range, 4-147) months, including 5 open thoracoabdominal aneurysm repairs. CONCLUSIONS Patients with ACTA2 variants frequently develop aortic aneurysm and are at risk of aortic dissection and coronary artery disease. However, age at diagnosis and symptoms at presentation are highly variable. Multiple operations are often required for disease management, particularly after dissection. Close monitoring and timely intervention are important in mitigating disease progression and improving outcomes.
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Affiliation(s)
- Jean-Luc A Maigrot
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick R Vargo
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Benjamin Kramer
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christina Rigelsky
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joanna Ghobrial
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth Zahka
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hani Najm
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Division of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Division of Pediatric and Congenital Heart Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Meuli L, Reutersberg B, Risteski P, Dzemali O, Zimmermann A. Hospital incidence, mortality, and gender disparities in patients treated for type A aortic dissections in Switzerland - a secondary data analysis of Swiss DRG statistics. Swiss Med Wkly 2023; 153:3499. [PMID: 38579314 DOI: 10.57187/s.3499] [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: 04/07/2024] Open
Abstract
AIMS OF THE STUDY The incidence of type A aortic dissection (TAAD) has increased in several countries in recent decades, but epidemiological data for Switzerland are lacking. Furthermore, there are conflicting data regarding a gender-disparity with higher type A aortic dissection mortality in women. This study analysed sex-specific hospital incidence and in-hospital mortality rates of TAAD in Switzerland. METHODS This study is a secondary data analysis of case-related hospital discharge data from the Swiss Federal Statistical Office for 2009-2018. Cases that were hospitalised and surgically treated for type A aortic dissection were included in this analysis. Standardised incidence rates were calculated using the European standard population in 2013. All-cause in-hospital mortality rates were calculated as raw values and standardised for age, sex, and the van Walraven comorbidity score. RESULTS A total of 2117 participants were included in this study, of whom 67.1% were male. The age-standardised cumulative hospital incidence for type A aortic dissection treatment was 3.5 per 100,000 (95% CI: 3.3-3.7) for men and 1.7 (1.6-1.8) per 100,000 for women (p <0.001). The incidence rates increased in both sexes during the observed decade. The adjusted mortality rates for treatment of TAAD decreased from 27.6% (26.7-28.5%) in 2009 to 18.5% (17.9-19.1%) in 2018 in women, and they decreased from 19.0% (18.4-19.6%) to 12.3% (11.9-12.7%) in the same period in men. Multivariable logistic regression analysis revealed that female sex was significantly associated with higher mortality, with an odds ratio of 1.39 (1.07-1.79) (p = 0.012). CONCLUSIONS Hospital incidence rates for the treatment of type A aortic dissection increased in both sexes over the observed decade. The mortality rate was significantly higher in women than it was in men, but it decreased in both sexes. TAAD remains a cardiovascular emergency with a high mortality rate even after emergency surgery.
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Affiliation(s)
- Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
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Kitlen E, Kim N, Rubenstein A, Keenan C, Garcia G, Khosla A, Johnson J, Miller PE, Wira C, Greer D, Gilmore EJ, Beekman R. Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest. Resuscitation 2023; 192:109955. [PMID: 37661012 DOI: 10.1016/j.resuscitation.2023.109955] [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: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Brain death (BD) occurs in 9-24% of successfully resuscitated out-of-hospital cardiac arrests (OHCA). To predict BD after OHCA, we developed a novel brain death risk (BDR) score. METHODS We identified independent predictors of BD after OHCA in a retrospective, single academic center cohort between 2011 and 2021. The BDR score ranges from 0 to 7 points and includes: non-shockable rhythm (1 point), drug overdose as etiology of arrest (1 point), evidence of grey-white differentiation loss or sulcal effacement on head computed tomography (CT) radiology report within 24 hours of arrest (2 points), Full-Outline-Of-UnResponsiveness (FOUR) score of 0 (2 points), FOUR score 1-5 (1 point), and age <45 years (1 point). We internally validated the BDR score using k-fold cross validation (k = 8) and externally validated the score at an independent academic center. The main outcome was BD. RESULTS The development cohort included 362OHCA patients, of whom 18% (N = 58) experienced BD. Internal validation provided an area under the receiving operator characteristic curve (AUC) (95% CI) of 0.931 (0.905-0.957). In the validation cohort, 19.8% (N = 17) experienced BD. The AUC (95% CI) was 0.849 (0.765-0.933). In both cohorts, a BDR score >4 was the optimal cut off (sensitivity 0.903 and 0.882, specificity 0.830 and 0.652, in the development and validation cohorts respectively). DISCUSSION The BDR score identifies those at highest risk for BD after OHCA. Our data suggest that a BDR score >4 is the optimal cut off.
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Affiliation(s)
- Eva Kitlen
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Noah Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Alexandra Rubenstein
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Caitlyn Keenan
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Gabriella Garcia
- Department of Neurology, University of Pennsylvania, PA, United States
| | - Akhil Khosla
- Department of Pulmonary Critical Care, Yale School of Medicine, New Haven, CT, United States
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - David Greer
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
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Jeoffrey SMH, Kalyanasundaram A, Zafar MA, Ziganshin BA, Elefteriades JA. Genetic Overlap of Spontaneous Dissection of Either the Thoracic Aorta or the Coronary Arteries. Am J Cardiol 2023; 205:69-74. [PMID: 37591066 DOI: 10.1016/j.amjcard.2023.07.046] [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: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 08/19/2023]
Abstract
Ascending thoracic aortic dissection (ATAD) is a well-known vascular cause of sudden death. Spontaneous coronary artery dissections (SCAD) are emerging as an important cause of early-onset myocardial infarction and sudden death. Genetic variants in multiple connective tissue genes have been recognized to underlie ATAD; other genetic variants have similarly been recognized to underlie SCAD. Little data are available regarding any genetic commonality between ATAD and SCAD. Our objective is to determine and characterize any genetic overlap between genes coding for ATAD and SCAD. We identified and reviewed 17 retrospective and prospective genetic studies of thoracic aortic dissection and SCAD published between 2016 and 2022 identified through PubMed and Orbis. Articles highlighting the significant plausible triggers for ATAD or SCAD individually were analyzed. No previous study reviewed both ATAD and SCAD genetics together. Separate lists of causative genes were constructed for ATAD and SCAD-and then commonalities were sought. A Venn diagram was constructed to display the genetic overlap and common physiologic pathways involved. We identified a definite, meaningful overlap of 15 independent genes based on a genome-wide association study or other genetic methods. The associated genetic pathways involved various biologic processes including elastin degradation, smooth muscle cell function, and the TGFβ-pathway. The overlapping genes included the following: COL3A1, TGFB2, SMAD3, MYLK, TGFBR2, TGFBR1, LOX, FBN1, NOTCH1, ELN, COL5A1, COL5A2, COL1A2, MYH11, and TLN1. The corresponding molecular pathways were investigated and correlated for both diseases. We are not aware of other studies searching for genetic commonalities between ATAD and SCAD. We have successfully identified overlapping genes-and their corresponding molecular pathways-for ATAD and SCAD. We hope that these insights will lead to further clinical and scientific understanding of each disease through study of their fundamental commonalities.
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Affiliation(s)
| | - Asanish Kalyanasundaram
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
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Branch KR, Nguyen ML, Kudenchuk PJ, Johnson NJ. Head-to-pelvis CT imaging after sudden cardiac arrest: Current status and future directions. Resuscitation 2023; 191:109916. [PMID: 37506817 DOI: 10.1016/j.resuscitation.2023.109916] [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: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Causes for sudden circulatory arrest (SCA) can vary widely making early treatment and triage decisions challenging. Additionally, cardiopulmonary resuscitation (CPR), while a life-saving link in the chain of survival, can be associated with traumatic injuries. Computed tomography (CT) can identify many causes of SCA as well as its sequelae. However, the diagnostic and therapeutic impact of CT in survivors of SCA has not been reviewed to date. This general review outlines the rationale and potential applications of focused head, chest, and abdomen/pelvis CT as well as comprehensive head-to-pelvis CT imaging after SCA. CT has a diagnostic yield approaching 30% to identify causes of SCA while the addition of ECG-gated chest CT provides further information about coronary anatomy and cardiac function. Risks of CT include radiation exposure, contrast-induced kidney injury, and incidental findings. This review's findings suggest that routine head-to-pelvis CT can yield clinically actional findings with the potential to improve clinical outcome after SCA that merits further investigation.
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Affiliation(s)
- Kelley R Branch
- Division of Cardiology, University of Washington, Seattle, WA, USA.
| | - My-Linh Nguyen
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | | | - Nicholas J Johnson
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Divsion of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
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Albano J, Conner TM. Does sodium bicarbonate significantly improve survival in asystolic and PEA out-of-hospital cardiac arrest? Resuscitation 2023; 191:109884. [PMID: 37748822 DOI: 10.1016/j.resuscitation.2023.109884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Jesse Albano
- Department of Pharmacy, Yale New Haven Health System, 20 York St., New Haven, CT 06510, USA.
| | - Todd M Conner
- Department of Pharmacy, Yale New Haven Health System, 20 York St., New Haven, CT 06510, USA
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Li Y, Li Z, Li C, Cai W, Liu T, Li J, Fan H, Cao C. Out-of-hospital cardiac arrest: A data-driven visualization of collaboration, frontier identification, and future trends. Medicine (Baltimore) 2023; 102:e34783. [PMID: 37603499 PMCID: PMC10443760 DOI: 10.1097/md.0000000000034783] [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: 03/23/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023] Open
Abstract
One of the main causes of death is out-of-hospital cardiac arrest (OHCA), which has a poor prognosis and poor neurological outcomes. This phenomenon has attracted increasing attention. However, there is still no published bibliometric analysis of OHCA. This bibliometric analysis of publications on OHCA aimed to visualize the current status of research, determine the frontiers of research, and identify future trends. Publications on OHCA were downloaded from the web of science database. The data elements included year, countries/territories, institutions, authors, journals, research areas, citations of publications, etc. Joinpoint regression and exponential models were used to identify and predict the trend of publications, respectively. Knowledge domain maps were applied to conduct contribution and collaboration, cooccurrence, cocitation, and coupled analyses. Timeline and burst detection analysis were used to identify the frontiers in the field. A total of 3 219 publications on OHCA were found from 1998 to 2022 (average annual percentage change = 16.7; 95% CI 14.4, 19.1). It was estimated that 859 articles and reviews would be published in 2025. The following research hotpots were identified: statement, epidemiology, clinical care, factors influencing prognosis and emergency medical services. The research frontier identification revealed that 7 categories were classified, including therapeutic hypothermia, emergency medical services, airway management, myocardial infarction, extracorporeal cardiopulmonary resuscitation, stroke foundation and trial. The burst detection analysis revealed that percutaneous coronary intervention, neurologic outcome, COVID-19 and extracorporeal cardiopulmonary resuscitation are issues that should be given continual attention in the future. This bibliometric analysis may reflect the current status and future frontiers of OHCA research.
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Affiliation(s)
- Yue Li
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Zhaoying Li
- Chest hospital, Tianjin University, Tianjin, China
| | - Chunjie Li
- Chest hospital, Tianjin University, Tianjin, China
| | - Wei Cai
- Department of Prevention and Therapy of Cardiovascular Diseases in Alpine Environment of Plateau, Characteristic Medical Center of the Chinese People’s Armed Police Forces, Tianjin, China
| | - Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Ji Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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12
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Ban E, Kalogerakos PD, Khosravi R, Ziganshin BA, Ellauzi H, Ramachandra AB, Zafar MA, Humphrey JD, Elefteriades JA. Extended law of laplace for measurement of the cloverleaf anatomy of the aortic root. Int J Cardiovasc Imaging 2023; 39:1345-1356. [PMID: 37046157 PMCID: PMC10250276 DOI: 10.1007/s10554-023-02847-5] [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: 11/30/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
The cross-sectional shape of the aortic root is cloverleaf, not circular, raising controversy regarding how best to measure its radiographic "diameter" for aortic event prediction. We mathematically extended the law of Laplace to estimate aortic wall stress within this cloverleaf region, simultaneously identifying a new metric of aortic root dimension that can be applied to clinical measurement of the aortic root and sinuses of Valsalva on clinical computerized tomographic scans. Enforcing equilibrium between blood pressure and wall stress, finite element computations were performed to evaluate the mathematical derivation. The resulting Laplace diameter was compared with existing methods of aortic root measurement across four patient groups: non-syndromic aneurysm, bicuspid aortic valve, Marfan syndrome, and non-dilated root patients (total 106 patients, 62 M, 44 F). (1) Wall stress: Mean wall stress at the depth of the sinuses followed this equation: Wall stress = BP × Circumscribing circle diameter/(2 × Aortic wall thickness). Therefore, the diameter of the circle enclosing the root cloverleaf, that is, twice the distance between the center, where the sinus-to-commissure lines coincide, and the depth of the sinuses, may replace diameter in the Laplace relation for a cloverleaf cross-section (or any shaped cross-section with two or more planes of symmetry). This mathematically derived result was verified by computational finite element analyses. (2) Diameters: CT scan measurements showed a significant difference between this new metric, the Laplace diameter, and the sinus-to-commissure, mid-sinus-to-mid-sinus, and coronal measurements in all four groups (p-value < 0.05). The average Laplace diameter measurements differed significantly from the other measurements in all patient groups. Among the various possible measurements within the aortic root, the diameter of the circumscribing circle, enclosing the cloverleaf, represents the diameter most closely related to wall stress. This diameter is larger than the other measurements, indicating an underestimation of wall stress by prior measurements, and otherwise provides an unbiased, convenient, consistent, physics-based measurement for clinical use. "Diameter" applies to circles. Our mathematical derivation of an extension of the law of Laplace, from circular to cloverleaf cross-sectional geometries of the aortic root, has implications for measurement of aortic root "diameter." The suggested method is as follows: (1) the "center" of the aortic root is identified by drawing three sinus-to-commissure lines. The intersection of these three lines identifies the "center" of the cloverleaf. (2) The largest radius from this center point to any of the sinuses is identified as the "radius" of the aortic root. (3) This radius is doubled to give the "diameter" of the aortic root. We find that this diameter best corresponds to maximal wall stress in the aortic root. Please note that this diameter defines the smallest circle that completely encloses the cloverleaf shape, touching the depths of all three sinuses.
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Affiliation(s)
- Ehsan Ban
- Department of Biomedical Engineering, Yale University, New Haven, USA
| | | | - Ramak Khosravi
- Department of Biomedical Engineering, Yale University, New Haven, USA
| | - Bulat A Ziganshin
- Aortic Institute, Yale School of Medicine, CB-3, 789 Howard Ave., New Haven, CT, 06510, USA
| | - Hesham Ellauzi
- Aortic Institute, Yale School of Medicine, CB-3, 789 Howard Ave., New Haven, CT, 06510, USA
| | | | - Mohammad A Zafar
- Aortic Institute, Yale School of Medicine, CB-3, 789 Howard Ave., New Haven, CT, 06510, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, USA
| | - John A Elefteriades
- Aortic Institute, Yale School of Medicine, CB-3, 789 Howard Ave., New Haven, CT, 06510, USA.
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13
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Benghanem S, Cariou A. CT-scan after cardiac arrest: allegro ma non troppo. Resuscitation 2023; 188:109820. [PMID: 37164177 DOI: 10.1016/j.resuscitation.2023.109820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Sarah Benghanem
- Medical Intensive Care Unit, Cochin University Hospital (AP-HP), Paris, France; University Paris Cité - Medical School, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin University Hospital (AP-HP), Paris, France; University Paris Cité - Medical School, Paris, France.
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14
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R. H. Branch K, Gatewood MO, Kudenchuk PJ, Maynard C, Sayre MR, Carlbom DJ, Edwards RM, Counts CR, Probstfield JL, Brusen R, Johnson N, Gunn ML. Diagnostic Yield, Safety, and Outcomes of Head-to-Pelvis Sudden Death CT Imaging in Post Arrest Care: The CT FIRST Cohort Study. Resuscitation 2023:109785. [PMID: 37019352 DOI: 10.1016/j.resuscitation.2023.109785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
AIM Our aim was to test whether a head-to-pelvis CT scan improves diagnostic yield and speed to identify causes for out of hospital circulatory arrest (OHCA). METHODS CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included unknown cause for arrest, age>18 years, stability to undergo CT, and no known cardiomyopathy or obstructive coronary artery disease. A head-to-pelvis sudden death CT (SDCT) scan within 6 hours of hospital arrival was added to the standard of care for patients resuscitated from OHCA (post-cohort) and compared to standard of care (SOC) alone (pre-cohort). The primary outcome was SDCT diagnostic yield. Secondary outcomes included time to identifying OHCA cause and time-critical diagnoses, SDCT safety, and survival to hospital discharge. RESULTS Baseline characteristics between the SDCT (N=104) and the SOC (N=143) cohorts were similar. CT scans (either head, chest, and/or abdomen) were ordered in 74 (52%) of SOC patients. Adding SDCT scanning identified 92% of causes for arrest compared to 75% (SOC-cohort; p value <0.001) and reduced the time to diagnosis by 78% (SDCT 3.1 hours, SOC alone 14.1 hours, p <0.0001). Identification of critical diagnoses was similar between cohorts, but SDCT reduced delayed (>6 hours) identification of critical diagnoses by 81% (p<0.001). SDCT safety endpoints were similar including acute kidney injury. Patient survival to discharge was similar between cohorts. DISCUSSION SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of arrest compared to the standard of care alone. CLINICAL TRIALS NUMBER NCT03111043.
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15
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Rashid M, Kinnaird T, Ludman P, Keeble TR, Mamas M, Curzen N. Variation in practice for out-of-hospital cardiac arrest treated with percutaneous coronary intervention in England and Wales. Catheter Cardiovasc Interv 2022; 100:306-316. [PMID: 35766046 DOI: 10.1002/ccd.30316] [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: 03/23/2022] [Revised: 05/05/2022] [Accepted: 06/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We assessed the association between total center volume, operator volume, and out-of-hospital cardiac arrest (OHCA) percutaneous coronary intervention (PCI) volume. BACKGROUND Variations between OHCA PCI volume, hospital total PCI, and primary PCI volume are not well studied and are unlikely to be clinically justifiable. METHODS Patients undergoing PCI for the acute coronary syndrome (ACS) between January 1, 2014, and March 31, 2019, in England and Wales were grouped as OHCA PCI and non-OHCA PCI. Spearman's correlation was used to determine the degree of correlation between each hospital PCI volume and OHCA PCI volume. RESULTS Out of 250,088 PCI procedures undertaken for ACS, 12,016 (4.8%) were performed for OHCA, and 238,072 (95.2%) were non-OHCA PCI procedures. The OHCA PCI group were younger [mean age (SD) 63.2 (12.3) and 65.6 (12.5, p < 0.001)], less likely to be female (20.2% vs. 26.9%, p < 0.001) or Black, Asian, and Minority Ethnicity (11.5% vs. 14.8%, p < 0.001) compared to the non-OHCA PCI group. Although there was a degree of correlation between total PCI and OHCA PCI, there was wide variation for both ACS cohort (Spearman correlation R2 = 0.50) and total PCI volume (Spearman correlation R2 = 0.60). Furthermore, the correlation between primary PCI volume and OHCA PCI within centers was weak (R2 = 0.10). Similarly, wide variations between operator PCI volume and OHCA PCI volume were observed. CONCLUSION These national data demonstrate wide variation in the practice of OHCA PCI both between centers and individuals. These variations are not expected according to clinical factors and require further investigation.
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Affiliation(s)
- Muhammad Rashid
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.,Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke on Trent, UK
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, Edgbaston, Birmingham, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, MSE, Basildon, UK.,MTRC, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Mamas Mamas
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.,Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke on Trent, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Cardiology, University Hospital NHS Trust, Southampton, UK
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16
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Gouveia e Melo R, Machado C, Caldeira D, Alves M, Lopes A, Serrano M, Fernandes e Fernandes R, Mendes Pedro L. Incidence of acute aortic dissections in patients with out of hospital cardiac arrest: A systematic review and meta-analysis of observational studies. IJC HEART & VASCULATURE 2022; 38:100934. [PMID: 35005212 PMCID: PMC8717414 DOI: 10.1016/j.ijcha.2021.100934] [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: 10/13/2021] [Revised: 11/28/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute Aortic dissection (AAD) may present as out-of-hospital cardiac arrest (OHCA). However, the incidence of this presentation is not well known. Our aim was to perform a systematic review and meta-analysis of all observational studies reporting on the incidence of AAD in patients with OHCA. METHODS We searched MEDLINE, CENTRAL, PsycInfo, Web of Science Core Collection and OpenGrey databases from inception to March-2021, for observational studies reporting on the incidence of AAD in patients with OHCA. Data was pooled using a random-effects model of proportions. The primary outcome was the incidence of AAD in OHCA patients. Secondary outcomes were the incidence of type A aortic dissections (TAAD) and type B aortic dissections (TBAD) in OHCA patients, overall mortality following AAD-OHCA and risk of death in AAD-OHCA patients compared to risk of death of non-AAD-OHCA patients. RESULTS Fourteen studies were included. The pooled calculated incidence of OHCA due to AAD was 4.39% (95 %CI: 2.55; 6.8). Incidence of OHCA due to TAAD was 7.18% (95 %CI: 5.61; 8.93) and incidence of OHCA due to TBAD was 0.47% (95 %CI: 0.18; 0.85). Overall mortality following OHCA due to AAD was 100% (95 %CI: 97.62; 100). The risk of death in AAD-OHCA patients compared with non-AAD-OHCA patients was 1.10 (95 %CI: 0.94; 1.30). CONCLUSION AAD as a cause of OHCA is more frequent than previously thought. Prognosis is dire, as it is invariably lethal. These findings should lead to a higher awareness of AAD when approaching a patient with OHCA and to future studies on this matter.
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Affiliation(s)
- Ryan Gouveia e Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Carolina Machado
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Daniel Caldeira
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Mariana Alves
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, Portugal
- Serviço de Medicina III, Hospital Pulido Valente (CHULN), Lisboa, Portugal
| | - Alice Lopes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Maria Serrano
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Intensive Medicine Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Ruy Fernandes e Fernandes
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN). Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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17
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Elefteriades JA, Ziganshin BA, Rizzo JA. Reply to the Positive Predictive Value of the Thumb-Palm Test for General Population Screening of Ascending Aortic Aneurysm. Am J Cardiol 2021; 161:117-118. [PMID: 34794610 DOI: 10.1016/j.amjcard.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 10/19/2022]
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18
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Elefteriades JA, Zafar MA, Ziganshin BA. Nationwide collaboration produces valuable data regarding arch and descending aorta. Eur Heart J 2021; 43:2370-2372. [PMID: 34904151 DOI: 10.1093/eurheartj/ehab854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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19
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Blumel R, Patel K, Rizzo JA, Mok S, Barrett A, Wu J, Zafar MA, Ziganshin BA, Elefteriades JA. Accuracy of the "Thumb-Palm Test" for Detection of Ascending Aortic Aneurysm. Am J Cardiol 2021; 150:114-116. [PMID: 34020772 DOI: 10.1016/j.amjcard.2021.03.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 01/18/2023]
Abstract
We have noticed, in caring for thousands of patients with ascending aortic aneurysm (AscAA), that the "thumb palm test" is often positive (with the thumb crossing beyond the edge of the palm). It is not known how accurate this test may be. We conducted the thumb-palm test in 305 patients undergoing cardiac surgery with intra-operative transesophageal echocardiography (TEE) for a variety of disorders: ascending aneurysm in 59 (19.4%) and non-AscAA disease in 246 (80.6%) (including CABG, valve repair, and descending aortic aneurysm). The TEE provided a precise ascending aortic diameter. The thumb palm test gave us a discrete, binary positive or negative result. We calculated the accuracy (sensitivity and specificity) of the thumb palm test in determining presence or absence of AscAA (defined as ascending aortic diameter > 3.8cm). Maximal ascending aortic diameters ranged from 2.0 to 6.6 cm (mean 3.48). 93 patients (30.6%) were classified as having an AscAA and 212 (69.4%) as not having an AscAA. 10 patients (3.3%) had a positive thumb-palm test and 295 patients (96.7%) did not. Sensitivity of the test (proportion of diseased patients correctly classified) was low (7.5%), but specificity (proportion of non-diseased patients correctly classified) was very high (98.5%). This study supports the utility of the thumb-palm test in evaluation for ascending thoracic aortic aneurysm. That is to say, a positive test implies a substantial likelihood of harboring an ascending aortic aneurysm. A negative test does not exclude an aneurysm. In other words, the majority of aneurysm patients do not manifest a positive thumb-palm sign, but patients who do have a positive sign have a very high likelihood of harboring an ascending aneurysm. We suggest that the thumb-palm test be part of the standard physical examination, especially in patients with suspicion of ascending aortic aneurysm (e.g. those with a positive family history).
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20
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
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21
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Branch KRH, Strote J, Gunn M, Maynard C, Kudenchuk PJ, Brusen R, Petek BJ, Sayre MR, Edwards R, Carlbom D, Counts CR, Probstfield JL, Gatewood MO. Early head-to-pelvis computed tomography in out-of-hospital circulatory arrest without obvious etiology. Acad Emerg Med 2021; 28:394-403. [PMID: 33606342 DOI: 10.1111/acem.14228] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Patients resuscitated from an out-of-hospital circulatory arrest (OHCA) commonly present without an obvious etiology. We assessed the diagnostic capability and safety of early head-to-pelvis computed tomography (CT) imaging in such patients. METHODS From November 2015 to February 2018, we enrolled 104 patients resuscitated from OHCA without obvious cause (idiopathic OHCA) to an early sudden-death CT (SDCT) scan protocol within 6 h of hospital arrival. The SDCT protocol included a noncontrast CT head, an electrocardiogram-gated cardiac and thoracic CT angiogram, and a nongated venous-phase abdominopelvic CT angiogram. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate SDCT were excluded. Cardiac CT analyses were blinded, but other SDCT findings were clinically available. Primary endpoints were the number of OHCA causes identified by SDCT compared to the adjudicated cause and critical diagnoses identified by SDCT, including resuscitation complications. Safety endpoints were acute kidney injury (AKI) and inappropriate treatments based on SDCT findings. Acute coronary syndrome was the presumed etiology if any major coronary artery had a >50% stenosis without another OHCA cause. RESULTS SDCT scans occurred within 1.9 ± 1.0 h of hospital arrival and identified 39% (41/104) of all OHCA causes and 95% (39/41) of causes potentially identifiable by SDCT. Critical findings were identified by SDCT in 98% (43/44) of patients that included potentially life-threatening resuscitation complications of liver or spleen laceration (n = 6); pneumothorax or thoracic organ laceration (n = 8); and mediastinal, pericardial, or vascular hemorrhage (n = 3). SDCT exclusively identified 13 (13%) OHCA causes that would otherwise not be identified without SDCT imaging. No inappropriate treatments resulted from SDCT findings. AKI was common (28%) but only one (1%) patient required new dialysis. CONCLUSIONS This observational cohort study suggests that early SDCT scanning is safe, can expedite the diagnosis of potential causes, and can meaningfully change clinical management after idiopathic OHCA.
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Affiliation(s)
| | - Jared Strote
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Martin Gunn
- Department of Radiology Harborview Medical Center Seattle Washington USA
| | - Charles Maynard
- Department of Health Services School of Public Health and Community Medicine University of Washington Seattle Washington USA
| | - Peter J. Kudenchuk
- Department of Cardiology University of Washington Seattle Washington USA
| | | | - Bradley J. Petek
- Internal Medicine Massachusetts General Hospital Boston Washington USA
| | - Michael R. Sayre
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | - Rachael Edwards
- Department of Radiology Harborview Medical Center Seattle Washington USA
| | - David Carlbom
- Pulmonary Critical Care and Sleep Medicine Harborview Medical Center Seattle Washington USA
| | - Catherine R. Counts
- Department of Emergency Medicine University of Washington Seattle Washington USA
| | | | - Medley O. Gatewood
- Department of Emergency Medicine University of Washington Seattle Washington USA
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22
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Association between Novel Marker (Platelet-Lymphocyte Ratio, Neutrophil-Lymphocyte Ratio, and Delta Neutrophil Index) and Outcomes in Sudden Cardiac Arrest Patients. Emerg Med Int 2021; 2021:6650958. [PMID: 33833877 PMCID: PMC8012140 DOI: 10.1155/2021/6650958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose It is important that clinicians accurately predict the outcome of patients with sudden cardiac arrest (SCA). The complete blood count (CBC) is an easy and inexpensive test that provides information on blood content. Platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), and delta neutrophil index (DNI) are relatively novel biomarkers that have been used in the prognosis of various diseases. We aimed to determine the usefulness of PLR, NLR, and DNI in predicting the outcomes of SCA. Materials and Methods This retrospective observational study was performed on patients with SCA. Patients who visited the tertiary university hospital from January 2015 to December 2019 were targeted. The inclusion criteria were all nontraumatic adult out-hospital cardiac arrest patients. We analyzed DNI, PLR, and NLR based on the CBC results of all enrolled patients. The exclusion criteria were as follows: no data on laboratory study, traumatic arrest, age < 18 years, and a history of leukemia, myelodysplastic syndrome, and myelofibrosis. The primary outcome was assessed as return of spontaneous circulation (ROSC), the secondary outcome as survival to discharge, and the tertiary outcome as neurological outcome. Results From January 1, 2015, to December 31, 2019, 739 patients were enrolled. ROSC was seen in 324 patients, of whom 60 had survival to discharge and 24 had good neurological outcome at the time of discharge (cerebral performance categories (CPCs) 1-2). The PLR of the ROSC group was 42.41 (range: 4.21–508.7), which was higher than that of the No-ROSC group (p=0.006). The DNI value of the survival group was 0.00 (range: 0.00–40.9), which was lower than that of the nonsurvival group. Conclusions Patients with SCA and subsequent ROSC had higher PLR and NLR, while those with survival to discharge had lower DNI values than those with nonsurvival to discharge (p=0.005).
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Commentary: Preventing the virulent lethality of ascending aortic aneurysm. J Thorac Cardiovasc Surg 2021; 163:2031-2033. [PMID: 33744012 DOI: 10.1016/j.jtcvs.2021.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Elefteriades JA, Ziganshin BA. Commentary: The elusive perfect criterion for aortic intervention. J Thorac Cardiovasc Surg 2020; 161:1198-1201. [PMID: 33160614 DOI: 10.1016/j.jtcvs.2020.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn
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Incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest evaluated by non-contrast computed tomography. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:S48-S57. [DOI: 10.1177/2048872620923647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background
The exact epidemiology of acute aortic dissection, including cases of out-of-hospital cardiopulmonary arrest, is unclear. We aimed to investigate the incidence and characteristics of acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest transferred to our institution and validate the related factors to out-of-hospital cardiopulmonary arrest in Stanford type A acute aortic dissection.
Methods
We retrospectively reviewed the acute-phase computed tomography data of patients with out-of-hospital cardiopulmonary arrest who visited our hospital between 1 January 2015 and 31 December 2017.
Results
Among 1011 consecutive patients with out-of-hospital cardiopulmonary arrest, excluding those aged 17 years and younger and exogenous out-of-hospital cardiopulmonary arrest, such as suicide and trauma, 934 underwent computed tomography examination and 71 (7.6%) were diagnosed with acute aortic dissection: 66 with Stanford type A and five with type B acute aortic dissection (out-of-hospital cardiopulmonary arrest group). Seventy-five patients without out-of-hospital cardiopulmonary arrest with Stanford type A acute aortic dissection visited our institution during the same period (non-out-of-hospital cardiopulmonary arrest group). Age, incidence of massive bloody pericardial effusion and massive intrathoracic haemorrhage were significantly higher in the out-of-hospital cardiopulmonary arrest than in the non-out-of-hospital cardiopulmonary arrest group (78 ± 8 years, 72.7% and 24.2% vs. 70 ± 13 years, 26.7% and 1.3%, respectively; all P < 0.01). These variables were independently related to out-of-hospital cardiopulmonary arrest.
Conclusions
There may be more patients with acute aortic dissection with out-of-hospital cardiopulmonary arrest than previously thought. Aortic rupture into the pericardial space or thoracic cavity is the major cause of out-of-hospital cardiopulmonary arrest in these cases. Non-contrast computed tomography can be used to diagnose acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest. Our study is one of a few to evaluate the real circumstances surrounding acute aortic dissection and its epidemiology.
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Elefteriades JA, Ziganshin BA. It Runs (Strongly) in the Family. J Am Coll Cardiol 2020; 76:1193-1196. [DOI: 10.1016/j.jacc.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/04/2023]
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Ota I, Kubota Y, Uejima T, Shigeoka H, Hiraide A. Outcomes after out-of-hospital cardiac arrests by anaphylaxis: A nationwide population-based observational study. Acute Med Surg 2020; 7:e458. [PMID: 31988770 PMCID: PMC6971466 DOI: 10.1002/ams2.458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 11/26/2022] Open
Abstract
AIM The objective of this study was to focus on outcomes of anaphylaxis-associated out-of hospital cardiac arrest (OHCA) in non-cardiac cases. METHODS All residents with OHCA due to non-cardiac cause in Japan from 2013 to 2015 were included for analysis. Propensity score matching and logistic regression analyses were used to assess outcome-related factors in anaphylaxis cases and non-anaphylaxis cases. The comparison group was comprised of non-anaphylaxis cases, which consisted of other cases of non-cardiac etiology. RESULTS A total of 375,874 OHCA cases were included, of which 148,598 were due to non-cardiac cause. In these non-cardiac OHCA cases, 147 were due to anaphylaxis, with an annual incidence of 0.04 per 100,000. In the patients' characteristics, witnessed ratio, shockable rhythm, defibrillation by emergency medical services (EMS), and treatment with adrenaline by EMS were significantly greater in the anaphylaxis cases compared with the non-anaphylaxis cases. In anaphylaxis cases, the crude 1-month survival rate (32.7% versus 5.3%) and crude favorable neurological outcomes rate (24.5% versus 2.2%) were higher compared with non-anaphylaxis cases (P < 0.001). The differences in outcomes between the two types of cases were also marked after we adjusted these variables by propensity score matching. By logistic regression analyses, administration of a drug by EMS was negatively associated with good neurological outcomes (odds ratio, 0.27; 95% confidence interval, 0.09-0.87), but bystander cardiopulmonary resuscitation was positively associated with good neurological outcomes (odds ratio, 2.33; 95% confidence interval, 0.99-5.52). CONCLUSION Neurological outcome was markedly more favorable in cases with anaphylaxis than non-anaphylaxis cases. Further studies are needed to explain this result.
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Affiliation(s)
- Ikuo Ota
- Department of Emergency MedicineNagayama HospitalSennanJapan
| | - Yoshie Kubota
- Institutional Research CenterKindai UniversityHigashiosakaJapan
| | - Toshifumi Uejima
- Department of Acute MedicineKindai UniversityOsakasayamaOsakaJapan
| | | | - Atsushi Hiraide
- Institutional Research CenterKindai UniversityHigashiosakaJapan
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Takeuchi S, Yamaguchi Y, Yoshino H. Non-contrast computed tomography of type A acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:1-5. [PMID: 31911991 PMCID: PMC6939809 DOI: 10.1093/ehjcr/ytz218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022]
Abstract
Background The prognosis of patients admitted for acute aortic dissection (AAD) has remarkably improved. However, we must also consider out-of-hospital cardiopulmonary arrest (OHCPA) patients while assessing the prognosis. In recent years, autopsy imaging has become more common as an alternative to conventional autopsy. Therefore, we reviewed our OHCPA patients with type A AAD using acute phase non-contrast computed tomography (CT). Case summary Here, we report a case series of three patients who developed OHCPA and were diagnosed with type A AAD using non-contrast CT. Although the direct causes of death varied in each case, we could easily determine the direct causes of death from clinical course of the condition and from non-contrast CT. Discussion Although non-contrast CT does not completely replace autopsy, if its convenience and non-invasiveness make it possible for more patients to undergo the procedure, the real prognosis (including morbidity and mortality) may be better understood. Therefore, we considered it significant to use non-contrast CT for investigating the cause of sudden death.
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Affiliation(s)
- Shinsuke Takeuchi
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
| | - Hideaki Yoshino
- Division of Cardiology, Second Department of Internal Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan
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Brede JR, Lafrenz T, Krüger AJ, Søvik E, Steffensen T, Kriesi C, Steinert M, Klepstad P. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic out-of-hospital cardiac arrest: evaluation of an educational programme. BMJ Open 2019; 9:e027980. [PMID: 31076474 PMCID: PMC6528011 DOI: 10.1136/bmjopen-2018-027980] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation during cardiopulmonary resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data support that patients in non-traumatic cardiac arrest might benefit from REBOA in the thoracic level during CPR. This study describes a training programme to implement the REBOA procedure to a prehospital working team, in preparation to a planned clinical study. METHODS We developed a team-based REBOA training programme involving the physicians and paramedics working on the National Air Ambulance helicopter base in Trondheim, Norway. The programme consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application scoring chart and a special designed simulation mannequin was made for this study. RESULTS Seven physicians and 3 paramedics participated. The time needed to perform the REBOA procedure was 8.5 (6.3-12.7) min. The corresponding time from arrival at scene to balloon inflation was 12.0 (8.8-15) min. The total objective assessment scores of the candidates' competency was 41.8 (39-43.5) points out of 48. The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure. CONCLUSION This four-step approach to educate, train and implement the REBOA procedure to a prehospital working team ensures adequate competence in a simulated OHCA setting. The use of a structured training programme and objective assessment of skills is recommended before utilising the procedure in a clinical setting. In a simulated setting, the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS. TRIAL REGISTRATION NUMBER NCT03534011.
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Affiliation(s)
- Jostein Rødseth Brede
- Department of emergency medicine and pre-hospital services, St. Olavs Hospital, Trondheim, Norway
- Departmentof research and development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of circulation and medical imaging, NTNU, Trondheim, Norway
| | - Thomas Lafrenz
- Department of thoracic anesthesiology and intensive care medicine, St. Olavs Hospital, Trondheim, Norway
| | - Andreas J Krüger
- Department of emergency medicine and pre-hospital services, St. Olavs Hospital, Trondheim, Norway
- Departmentof research and development, Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of circulation and medical imaging, NTNU, Trondheim, Norway
| | - Edmund Søvik
- Department of radiology and nuclear medicine, St. Olavs Hospital, Trondheim, Norway
| | - Torjus Steffensen
- Department of mechanical and industrial engineering, NTNU, Trondheim, Norway
| | - Carlo Kriesi
- Department of mechanical and industrial engineering, NTNU, Trondheim, Norway
| | - Martin Steinert
- Department of mechanical and industrial engineering, NTNU, Trondheim, Norway
| | - Pål Klepstad
- Department of circulation and medical imaging, NTNU, Trondheim, Norway
- Department of anesthesiology and intensive care medicine, St. Olavs Hospital, Trondheim, Norway
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Saeyeldin A, Zafar MA, Li Y, Tanweer M, Abdelbaky M, Gryaznov A, Brownstein AJ, Velasquez CA, Buntin J, Thombre K, Ma WG, Erben Y, Rizzo JA, Ziganshin BA, Elefteriades JA. Decision-making algorithm for ascending aortic aneurysm: Effectiveness in clinical application? J Thorac Cardiovasc Surg 2019; 157:1733-1745. [DOI: 10.1016/j.jtcvs.2018.09.124] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/21/2018] [Accepted: 09/04/2018] [Indexed: 01/15/2023]
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Abstract
Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Regional variations in reporting frameworks and survival mean the exact burden of OHCA to public health is unknown. Nevertheless, overall prognosis and neurological outcome are relatively poor following OHCA and have remained almost static for the past three decades. In this Series paper, we explore the aetiology of OHCA. Coronary artery disease remains the predominant cause, but there is a diverse range of other potential cardiac and non-cardiac causes to be aware of. Additionally, we describe how investigators and key stakeholders in resuscitation science have formulated specific Utstein data element domains in an attempt to standardise the definitions and outcomes reported in OHCA research so that management pathways can be improved. Finally, we identify the predictors of survival after OHCA and what primary and secondary prevention strategies can be instigated to mitigate the devastating sequelae of this growing public health issue.
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Affiliation(s)
- Aung Myat
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Division of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK.
| | - Kyoung-Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, South Korea
| | - Thomas Rea
- Division of General Internal Medicine, Harborview Medical Centre, University of Washington, Seattle, WA, USA
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Hensel M, Geppert D, Kersten JF, Stuhr M, Lorenz J, Wirtz S, Kerner T. Association between Weather-Related Factors and Cardiac Arrest of Presumed Cardiac Etiology: A Prospective Observational Study Based on Out-of-Hospital Care Data. PREHOSP EMERG CARE 2018; 22:345-352. [PMID: 29345516 DOI: 10.1080/10903127.2017.1381790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to determine the association between weather-related factors and out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology. METHODS This was a prospective observational study performed in a prehospital setting. Data from the Emergency Medical Service in Hamburg (Germany) and data from the local weather station were evaluated over a 5-year period. Weather data (temperature, humidity, air pressure, wind speed) were obtained every minute and matched with the associated rescue mission data. Lowess-Regression analysis was performed to assess the relationship between the above-mentioned weather-related factors and OHCA of presumed cardiac etiology. Additionally, varying measuring-ranges were defined for each weather-related factor in order to compare them with each other with regard to the probability of occurrence of OHCA. RESULTS During the observation period 1,558 OHCA with presumed cardiac etiology were registered (age: 67 ± 19 yrs; 62% male; hospital admission: 37%; survival to hospital discharge: 6.7%). Compared to moderate temperatures (5 - 25°C), probability of OHCA-occurrence increased significantly at temperatures above 25°C (p = 0.028) and below 5°C p = 0.011). Regarding air humidity, probability of OHCA-occurrence increased below a threshold-value of 75% compared to values above this cut-off (p = 0.006). Decreased probability was seen at moderate atmospheric pressure (1000 hPa - 1020 hPa), whereas increased probability was seen above 1020 hPa (p = 0.023) and below 1000 hPa (p = 0.035). Probability of OHCA-occurrence increased continuously with increasing wind speed (p < 0.001). CONCLUSIONS There are associations between several weather-related factors such as temperature, humidity, air pressure, and wind speed, and occurrence of OHCA of presumed cardiac etiology. Particularly dangerous seem to be cold weather, dry air and strong wind.
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Gryaznov AA, Ziganshin BA, Elefteriades JA. Time to Move to Earlier Intervention for Thoracic Aortic Aneurysm? STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1404664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Anton A. Gryaznov
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bulat A. Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John A. Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
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Ho N, Mohadjer A, Desai MY. Thoracic aortic aneurysms: state of the art and current controversies. Expert Rev Cardiovasc Ther 2017; 15:667-680. [DOI: 10.1080/14779072.2017.1362983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Natalie Ho
- Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ashley Mohadjer
- Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y. Desai
- Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Daley J, Morrison JJ, Sather J, Hile L. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest. Am J Emerg Med 2017; 35:731-736. [PMID: 28117180 DOI: 10.1016/j.ajem.2017.01.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 11/19/2022] Open
Abstract
Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. If we hope to increase the survivability of this condition, it is imperative that alternative methods of treatment are given due consideration. Balloon occlusion of the aorta can be used as a method of circulatory support in the critically ill patient. Intra-aortic balloon pumps have been used to temporize patients in cardiogenic shock for decades. More recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been utilized in the patient in hemorrhagic shock or cardiac arrest secondary to trauma. Aortic occlusion in non-traumatic cardiac arrest has the effect of reducing the vascular volume that the generated cardiac output is distributed across. This augments myocardial and cerebral perfusion, increasing the probability of a return to a good quality of life for the patient. This phenomenon has been the subject of numerous animal studies dating back to the early 1980s; however, the human evidence is limited to several small case series. Animal research has demonstrated improvements in cerebral and coronary perfusion pressure during ACLS that lead to statistically significant differences in mortality. Several case series in humans have replicated these findings, suggesting the efficacy of this procedure. The objectives of this review are to: 1) introduce the reader to REBOA 2) review the physiology of NTCA and examine the current limitations of traditional ACLS 3) summarize the literature regarding the efficacy and feasibility of aortic balloon occlusion to support traditional ACLS.
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Affiliation(s)
- James Daley
- Yale New Haven Hospital, Department of Emergency Medicine, New Haven, CT, United States.
| | - Jonathan James Morrison
- Queen Elizabeth University Hospital, Department of Vascular Surgery, Glasgow, United Kingdom
| | - John Sather
- Yale New Haven Hospital, Department of Emergency Medicine, New Haven, CT, United States
| | - Lisa Hile
- Johns Hopkins Medicine, Department of Emergency Medicine, Baltimore, MD, United States
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Tanaka Y, Sakata K, Sakurai Y, Yoshimuta T, Morishita Y, Nara S, Takahashi I, Hirokami M, Yamagishi M. Prevalence of Type A Acute Aortic Dissection in Patients With Out-Of-Hospital Cardiopulmonary Arrest. Am J Cardiol 2016; 117:1826-30. [PMID: 27067619 DOI: 10.1016/j.amjcard.2016.03.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 11/15/2022]
Abstract
Postmortem computed tomography (PMCT) has been recently reported to be useful for detecting causes of death in the emergency department. In this study, the incidence and causes of death of type A acute aortic dissection (AAD) were investigated in patients who experienced out-of-hospital cardiopulmonary arrest (OHCPA) using PMCT. PMCT or enhanced computed tomography was performed in 311 of 528 consecutive patients experiencing OHCPA. A total of 23 (7%) of 311 patients were diagnosed with type A AAD based on clinical courses and CT findings. Eighteen consecutive patients who did not experience OHCPA were diagnosed with type A AAD during the same period. Pre-hospital death was observed in 21 (51%) of 41 patients with type A AAD. Bloody pericardial effusion was observed more frequently in patients who experienced OHCPA with type A AAD than in those who did not experience OHCPA with type A AAD (91% vs 28%, respectively; p <0.05). In conclusion, the incidence of type A AAD was common (7%) in patients who experienced OHCPA, with a high rate of pre-hospital death. Aortic rupture to the intrapericardial space was considered the major cause of death in patients who experienced OHCPA with type A AAD.
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Affiliation(s)
- Yoshihiro Tanaka
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yasuo Sakurai
- Division of Radiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Yoshimuta
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yuka Morishita
- Division of Emergency and Critical Care Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoshi Nara
- Division of Emergency and Critical Care Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Isao Takahashi
- Division of Emergency and Critical Care Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Mitsugu Hirokami
- Division of Cardiovascular Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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Use of computed tomography and mechanical CPR in cardiac arrest to confirm pulmonary embolism: a case study. CAN J EMERG MED 2015; 18:66-9. [PMID: 25912517 DOI: 10.1017/cem.2015.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Precise therapeutic decision-making is vital in managing out-of-hospital cardiac arrest. We present an interesting approach where suspected pulmonary embolism could be confirmed by early computed tomography in cardiac arrest. Chest compressions were performed automatically by mechanical devices also during the acquisition of computed tomography data and subsequent thrombolysis.
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40
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Moriwaki Y, Tahara Y, Iwashita M, Kosuge T, Suzuki N. Risky locations for out-of-hospital cardiopulmonary arrest in a typical urban city. J Emerg Trauma Shock 2014; 7:285-94. [PMID: 25400390 PMCID: PMC4231265 DOI: 10.4103/0974-2700.142763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/27/2013] [Indexed: 11/18/2022] Open
Abstract
Background: The aim of this study is to clarify the circumstances including the locations where critical events resulting in out-of-hospital cardiopulmonary arrest (OHCPA) occur. Materials and Methods: Subjects of this population-based observational case series study were the clinical records of patients with nontraumatic and nonneck-hanging OHCPA. Results: Of all 1546 cases, 10.3% occurred in a public place (shop, restaurant, workplace, stations, public house, sports venue, and bus), 8.3% on the street, 73.4% in a private location (victim's home, the homes of the victims’ relatives or friends or cheap bedrooms, where poor homeless people live), and 4.1% in residential institutions. In OHCPA occurring in private locations, the frequency of asystole was higher and the outcome was poorer than in other locations. A total of 181 OHCPA cases (11.7%) took place in the lavatory and 166 (10.7%) in the bathroom; of these, only 7 (3.9% of OHCPA in the lavatory) and none in the bath room achieved good outcomes. The frequencies of shockable initial rhythm occurring in the lavatory and in bath room were 3.7% and 1.1% (lower than in other locations, P = 0.011 and 0.002), and cardiac etiology in OHCPA occurring in these locations were 46.7% and 78.4% (the latter higher than in other locations, P < 0.001). Conclusions: An unignorable population suffered from OHCPA in private locations, particularly in the lavatory and bathroom; their initial rhythm was usually asystole and their outcomes were poor, despite the high frequency of cardiac etiology in the bathroom. We should try to treat OHCPA victims and to prevent occurrence of OHCPA in these risky spaces by considering their specific conditions.
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Affiliation(s)
- Yoshihiro Moriwaki
- Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshio Tahara
- Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Masayuki Iwashita
- Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takayuki Kosuge
- Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Noriyuki Suzuki
- Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
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Sittichanbuncha Y, Prachanukool T, Sawanyawisuth K. A 6-year experience of CPR outcomes in an emergency department in Thailand. Ther Clin Risk Manag 2013; 9:377-81. [PMID: 24143107 PMCID: PMC3797279 DOI: 10.2147/tcrm.s50981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Sudden cardiac arrest is a common emergency condition found in the emergency department of the hospital. The survival rate of out-of-hospital cardiac arrest patients is 2.0%–10.0% and 7.4%–27.0% percent for in-hospital cardiac arrest patients. The factors for survival outcome are divided into three main groups: patient characteristics, pre-hospital factors, and resuscitated information. The objective of this study was to evaluate the related factors, outcome, and survival rate in patients with cardiac arrest who received cardiopulmonary resuscitation (CPR) at Ramathibodi Emergency Medicine Department. There are limited data for this issue in Thailand and other Asian countries. Methods This retrospective study included all patients who were older than 15 years with sudden cardiac arrest and who were resuscitated in the emergency room between January 2005 and December 2010. Descriptive analytic statistics and logistic regressions were used to analyze factors that related to the sustained return of spontaneous circulation (ROSC) and survival at discharge. Results There were 181 patients enrolled. The overall sustained ROSC rate was 34.8% and the survival rate at discharge was 11.1%. There were 145 out-of-hospital cardiac arrest patients, in whom the survival rate was 52.4% and the survival to discharge rate was 7.6%. For inhospital cardiac arrest, there were 36 patients with a survival rate of 86.1% and the survival to discharge rate was 25.0%. Statistically significant factors related to sustained ROSC were good and moderate cerebral performance, in-hospital cardiac arrest, beginning of CPR in less than 30 minutes, and cardiopulmonary cause of arrest. The factors influencing survival to discharge were cardiopulmonary causes of cardiac arrest. Conclusion Factors associated with sustained ROSC were functional status before cardiac arrest, location of cardiac arrest, duration of CPR, and cause of cardiac arrest. Survival rate was related to the cause of cardiac arrest.
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Affiliation(s)
- Yuwares Sittichanbuncha
- Emergency Medicine Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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