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Kruit N, Burrell A, Tian D, Barrett N, Bělohlávek J, Bernard S, Braude D, Buscher H, Chen YS, Donker DW, Finney S, Forrest P, Fowles JA, Hifumi T, Hodgson C, Hutin A, Inoue A, Jung JS, Kruse JM, Lamhaut L, Ming-Hui Lin R, Reis Miranda D, Müller T, Bhagyalakshmi Nanjayya V, Nickson C, Pellegrino V, Plunkett B, Richardson C, Alexander Richardson S, Shekar K, Shinar Z, Singer B, Stub D, Totaro RJ, Vuylsteke A, Yannopoulos D, Zakhary B, Dennis M. Corrigendum to "Expert consensus on training and accreditation for extracorporeal cardiopulmonary resuscitation an international, multidisciplinary modified Delphi Study" [Resuscitation 192 (2023) 109989]. Resuscitation 2024; 194:110046. [PMID: 37996305 DOI: 10.1016/j.resuscitation.2023.110046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Affiliation(s)
- Natalie Kruit
- Department of Perioperative Medicine, Westmead Hospital, Hawksbury Rd, Westmead, NSW 2145, Australia.
| | - Aidan Burrell
- The Alfred Hospital, Melbourne, Victoria, Australia.
| | | | | | - Jan Bělohlávek
- Chair EuroELSO Working Group on ECPR, Deputy Head, 2nd Dept. of Internal Medicine, Cardiovascular Medicine U Nemocnice 2, Prague 2 128 00, Czech Republic.
| | | | - Darren Braude
- Division of Prehospital, Austere and Disaster Medicine, NM, USA.
| | | | | | | | | | - Paul Forrest
- RPAH and Sydney University Medical School, Australia.
| | - Jo-Anne Fowles
- Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus l Cambridge, UK.
| | - Toru Hifumi
- St. Luke's International Hospital, Tokyo, Japan.
| | | | - Alice Hutin
- Assistance Publique-Hôpitaux de Paris, Paris, France.
| | | | - Jae-Seung Jung
- Korea University Anam Hospital, Seoul, Republic of Korea.
| | - J M Kruse
- Charité - Universitätsmedizin Berlin, Germany.
| | | | - Richard Ming-Hui Lin
- Director of Emergency and Critical Care Services, Lin Shin Hospital, Taichung, Taiwan.
| | | | | | | | | | | | | | | | | | - Kiran Shekar
- The Prince Charles Hospital, Brisbane, QLD, Australia.
| | | | - Ben Singer
- St Bartholomew's Hospital, London, UK London's Air Ambulance, London, UK.
| | - Dion Stub
- The Alfred Hosptial, Victoria, Australia.
| | | | | | | | | | - Mark Dennis
- Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Australia.
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Kruit N, Burrell A, Tian D, Barrett N, Bělohlávek J, Bernard S, Braude D, Buscher H, Chen YS, Donker DW, Finney S, Forrest P, Fowles JA, Hifumi T, Hodgson C, Hutin A, Inoue A, Jung JS, Kruse JM, Lamhaut L, Ming-Hui Lin R, Reis Miranda D, Müller T, Bhagyalakshmi Nanjayya V, Nickson C, Pellegrino V, Plunkett B, Richardson C, Alexander Richardson S, Shekar K, Shinar Z, Singer B, Stub D, Totaro RJ, Vuylsteke A, Yannopoulos D, Zakhary B, Dennis M. Expert consensus on training and accreditation for extracorporeal cardiopulmonary resuscitation an international, multidisciplinary modified Delphi Study. Resuscitation 2023; 192:109989. [PMID: 37805061 DOI: 10.1016/j.resuscitation.2023.109989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND A multidisciplinary group of stakeholders were used to identify: (1) the core competencies of a training program required to perform in-hospital ECPR initiation (2) additional competencies required to perform pre-hospital ECPR initiation and; (3) the optimal training method and maintenance protocol for delivering an ECPR program. METHODS A modified Delphi process was undertaken utilising two web based survey rounds and one virtual meeting. Experts rated the importance of different aspects of ECPR training, competency and governance on a 9-point Likert scale. A diverse, representative group was targeted. Consensus was achieved when greater than 70% respondents rated a domain as critical (> or = 7 on the 9 point Likert scale). RESULTS 35 international ECPR experts from 9 countries formed the expert panel, with a median number of 14 years of ECMO practice (interquartile range 11-38). Participant response rates were 97% (survey round one), 63% (virtual meeting) and 100% (survey round two). After the second round of the survey, 47 consensus statements were formed outlining a core set of competencies required for ECPR provision. We identified key elements required to safely train and perform ECPR including skill pre-requisites, surrogate skill identification, the importance of competency-based assessment over volume of practice and competency requirements for successful ECPR practice and skill maintenance. CONCLUSIONS We present a series of core competencies, training requirements and ongoing governance protocols to guide safe ECPR implementation. These findings can be used to develop training syllabus and guide minimum standards for competency as the growth of ECPR practitioners continues.
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Affiliation(s)
- Natalie Kruit
- Department of Perioperative Medicine, Westmead Hospital, Hawksbury Rd, Westmead, NSW 2145, Australia.
| | - Aidan Burrell
- The Alfred Hospital, Melbourne, Victoria, Australia.
| | | | | | - Jan Bělohlávek
- Chair EuroELSO Working Group on ECPR, Deputy Head, 2(nd) Dept. of Internal Medicine, Cardiovascular Medicine U Nemocnice 2, Prague 2 128 00, Czech Republic.
| | | | - Darren Braude
- Division of Prehospital, Austere and Disaster Medicine, NM, United States.
| | | | | | | | | | - Paul Forrest
- RPAH and Sydney University Medical School, Australia.
| | - Jo-Anne Fowles
- Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus l Cambridge, UK.
| | - Toru Hifumi
- St. Luke's International Hospital, Tokyo, Japan.
| | | | - Alice Hutin
- Assistance Publique-Hôpitaux de Paris, Paris, France.
| | | | - Jae-Seung Jung
- Korea University Anam Hospital, Seoul, Republic of Korea.
| | - J M Kruse
- Charité - Universitätsmedizin Berlin, Germany.
| | | | - Richard Ming-Hui Lin
- Director of Emergency and Critical Care Services, Lin Shin Hospital, Taichung, Taiwan.
| | | | | | | | | | | | | | | | | | - Kiran Shekar
- The Prince Charles Hospital, Brisbane, QLD, Australia.
| | | | - Ben Singer
- St Bartholomew's Hospital, London, UK London's Air Ambulance, London, UK.
| | - Dion Stub
- The Alfred Hosptial, Victoria, Australia.
| | | | | | | | | | - Mark Dennis
- Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Australia.
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Steiner S, Schwarz T, Corman VM, Gebert L, Kleinschmidt MC, Wald A, Gläser S, Kruse JM, Zickler D, Peric A, Meisel C, Meyer T, Staudacher OL, Wittke K, Kedor C, Bauer S, Besher NA, Kalus U, Pruß A, Drosten C, Volk HD, Scheibenbogen C, Hanitsch LG. SARS-CoV-2 T Cell Response in Severe and Fatal COVID-19 in Primary Antibody Deficiency Patients Without Specific Humoral Immunity. Front Immunol 2022; 13:840126. [PMID: 35359967 PMCID: PMC8960624 DOI: 10.3389/fimmu.2022.840126] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 12/19/2022] Open
Abstract
Morbidity and mortality of COVID-19 is increased in patients with inborn errors of immunity (IEI). Age and comorbidities and also impaired type I interferon immunity were identified as relevant risk factors. In patients with primary antibody deficiency (PAD) and lack of specific humoral immune response to SARS-CoV-2, clinical disease outcome is very heterogeneous. Despite extensive clinical reports, underlying immunological mechanisms are poorly characterized and levels of T cellular and innate immunity in severe cases remain to be determined. In the present study, we report clinical and immunological findings of 5 PAD patients with severe and fatal COVID-19 and undetectable specific humoral immune response to SARS-CoV-2. Reactive T cells to SARS-CoV-2 spike (S) and nucleocapsid (NCAP) peptide pools were analyzed comparatively by flow cytometry in PAD patients, convalescents and naïve healthy individuals. All examined PAD patients developed a robust T cell response. The presence of polyfunctional cytokine producing activated CD4+ T cells indicates a memory-like phenotype. An analysis of innate immune response revealed elevated CD169 (SIGLEC1) expression on monocytes, a surrogate marker for type I interferon response, and presence of type I interferon autoantibodies was excluded. SARS-CoV-2 RNA was detectable in peripheral blood in three severe COVID-19 patients with PAD. Viral clearance in blood was observed after treatment with COVID-19 convalescent plasma/monoclonal antibody administration. However, prolonged mucosal viral shedding was observed in all patients (median 67 days) with maximum duration of 127 days. PAD patients without specific humoral SARS-CoV-2 immunity may suffer from severe or fatal COVID-19 despite robust T cell and normal innate immune response. Intensified monitoring for long persistence of SARS-CoV-2 viral shedding and (prophylactic) convalescent plasma/specific IgG as beneficial treatment option in severe cases with RNAemia should be considered in seronegative PAD patients.
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Affiliation(s)
- Sophie Steiner
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany
| | - Tatjana Schwarz
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and German Centre for Infection Research, Associated Partner, Charitéplatz 1, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Victor M Corman
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and German Centre for Infection Research, Associated Partner, Charitéplatz 1, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Gebert
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany
| | - Malte C Kleinschmidt
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexandra Wald
- Department of Pulmonary Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Sven Gläser
- Department of Pulmonary Medicine and Infectious Diseases, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Jan M Kruse
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Peric
- Department of Pulmonary Medicine and Infectious Diseases, Vivantes-Klinikum Friedrichshain, Berlin, Germany
| | - Christian Meisel
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany.,Department of Immunology, Labor Berlin GmbH, Berlin, Germany
| | - Tim Meyer
- Department of Immunology, Labor Berlin GmbH, Berlin, Germany
| | - Olga L Staudacher
- Department of Immunology, Labor Berlin GmbH, Berlin, Germany.,Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirsten Wittke
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany
| | - Claudia Kedor
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany
| | - Sandra Bauer
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany
| | - Nabeel Al Besher
- Institute of Transfusion Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Kalus
- Institute of Transfusion Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Pruß
- Institute of Transfusion Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and German Centre for Infection Research, Associated Partner, Charitéplatz 1, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Dieter Volk
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Charitéplatz 1, Berlin, Germany.,Berlin Center for Advanced Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies, Charitéplatz 1, Berlin, Germany
| | - Leif G Hanitsch
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1 and Berlin Institute of Health, Berlin, Germany
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Van De Ginste L, Vanommeslaeghe F, Hoste EAJ, Kruse JM, Van Biesen W, Verbeke F. Patients with Severe Lactic Acidosis in the Intensive Care Unit: A Retrospective Study of Contributing Factors and Impact of Renal Replacement Therapy. Blood Purif 2021; 51:577-583. [PMID: 34525474 DOI: 10.1159/000518918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hyperlactatemia is a regular condition in the intensive care unit, which is often associated with adverse outcomes. Control of the triggering condition is the most effective treatment of hyperlactatemia, but since this is mostly not readily possible, extracorporeal renal replacement therapy (RRT) is often tried as a last resort. The present study aims to evaluate the factors that may contribute to the decision whether to start RRT or not and the potential impact of the start of RRT on the outcome in patients with severe lactic acidosis (SLA) (lactate ≥5 mmol/L). MATERIALS AND METHODS We conducted a retrospective single-center cohort analysis over a 3-year period including all patients with a lactate level ≥5 mmol/L. Patients were considered as treated with RRT because of SLA if RRT was started within 24 h after reaching a lactate level ≥5 mmol/L. RESULTS Overall, 90-day mortality in patients with SLA was 34.5%. Of the 1,203 patients who matched inclusion/exclusion criteria, 11% (n = 133) were dialyzed within 24 h. The propensity to receive RRT was related to the lactate level and to the SOFA renal and cardio score. The most frequently used modality was continuous RRT. Patients who were started on RRT versus those who did not have 2.3 higher odds of mortality, even after adjustment for the propensity to start RRT. CONCLUSIONS Our analysis confirms the high mortality rate of patients with SLA. It adds that odds for mortality is even higher in patients who were started on RRT versus not. We suggest keeping an open mind to the factors that may influence the decision to start dialysis and bear in mind that without being a bridge to correction of the underlying condition, dialysis is unlikely to affect the outcome.
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Affiliation(s)
| | | | - Eric A J Hoste
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jan M Kruse
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Francis Verbeke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
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5
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Nee J, Koerner R, Zickler D, Schroeder T, Enghard P, Nibbe L, Hasper D, Buder R, Leithner C, Ploner CJ, Eckardt KU, Storm C, Kruse JM. Establishment of an extracorporeal cardio-pulmonary resuscitation program in Berlin - outcomes of 254 patients with refractory circulatory arrest. Scand J Trauma Resusc Emerg Med 2020; 28:96. [PMID: 32972428 PMCID: PMC7513459 DOI: 10.1186/s13049-020-00787-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Optimal management of out of hospital circulatory arrest (OHCA) remains challenging, in particular in patients who do not develop rapid return of spontaneous circulation (ROSC). Extracorporeal cardiopulmonary resuscitation (eCPR) can be a life-saving bridging procedure. However its requirements and feasibility of implementation in patients with OHCA, appropriate inclusion criteria and achievable outcomes remain poorly defined. Design Prospective cohort study. Setting Tertiary referral university hospital center. Patients Here we report on characteristics, course and outcomes on the first consecutive 254 patients admitted between August 2014 and December 2017. Intervention eCPR program for OHCA. Mesurements and main results A structured clinical pathway was designed and implemented as 24/7 eCPR service at the Charité in Berlin. In total, 254 patients were transferred with ongoing CPR, including automated chest compression, of which 30 showed or developed ROSC after admission. Following hospital admission predefined in- and exclusion criteria for eCPR were checked; in the remaining 224, 126 were considered as eligible for eCPR. State of the art postresuscitation therapy was applied and prognostication of neurological outcome was performed according to a standardized protocol. Eighteen patients survived, with a good neurological outcome (cerebral performance category (CPC) 1 or 2) in 15 patients. Compared to non-survivors survivors had significantly shorter time between collaps and start of eCPR (58 min (IQR 12–85) vs. 90 min (IQR 74–114), p = 0.01), lower lactate levels on admission (95 mg/dL (IQR 44–130) vs. 143 mg/dL (IQR 111–178), p < 0.05), and less severe acidosis on admission (pH 7.2 (IQR 7.15–7.4) vs. 7.0 (IQR6.9–7.2), p < 0.05). Binary logistic regression analysis identified latency to eCPR and low pH as independent predictors for mortality. Conclusion An eCPR program can be life-saving for a subset of individuals with refractory circulatory arrest, with time to initiation of eCPR being a main determinant of survival.
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Affiliation(s)
- Jens Nee
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Roland Koerner
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tim Schroeder
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp Enghard
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lutz Nibbe
- Department of Emergency and Intensive Care Medicine, Ernst von Bergmann Klinikum, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Dietrich Hasper
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Buder
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Leithner
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jan M Kruse
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Enghard P, Rademacher S, Nee J, Hasper D, Engert U, Jörres A, Kruse JM. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water in ventilated intensive care patients. Crit Care 2015; 19:36. [PMID: 25656060 PMCID: PMC4335373 DOI: 10.1186/s13054-015-0756-5] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/19/2015] [Indexed: 12/04/2022]
Abstract
Introduction Ultrasound of the lung and quantification of B lines was recently introduced as a novel tool to detect overhydration. In the present study, we aimed to evaluate a four-region protocol of lung ultrasound to determine the pulmonary fluid status in ventilated patients in the intensive care unit. Methods Fifty patients underwent both lung ultrasound and transpulmonary thermodilution measurement with the PiCCO system. An ultrasound score based on number of single and confluent B lines per intercostal space was used to quantify pulmonary overhydration. To check for reproducibility, two different intensivists who were blinded as to the ultrasound pictures reassessed and classified them using the same scoring system. The results were compared with those obtained using other methods of evaluating hydration status, including extravascular lung water index (EVLWI) and intrathoracic blood volume index calculated with data from transpulmonary thermodilution measurements. Moreover, chest radiographs were assessed regarding signs of pulmonary overhydration and categorized based on a numeric rating scale. Results Lung water assessment by ultrasound using a simplified protocol showed excellent correlation with EVLWI over a broad range of lung hydration grades and ventilator settings. Correlation of chest radiography and EVLWI was less accurate. No correlation whatsoever was found with central venous pressure measurement. Conclusion Lung ultrasound is a useful, non-invasive tool in predicting hydration status in mechanically ventilated patients. The four-region protocol that we used is time-saving, correlates well with transpulmonary thermodilution measurements and performs markedly better than chest radiography.
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Affiliation(s)
- Philipp Enghard
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivemdizin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Sibylle Rademacher
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivemdizin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Jens Nee
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivemdizin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Dietrich Hasper
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivemdizin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ulrike Engert
- Abteilung für Radiologie, Charité Universitätsmedizin Berlin, Augstenburger Platz 1, 13353, Berlin, Germany.
| | - Achim Jörres
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivemdizin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Jan M Kruse
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivemdizin, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Kruse JM, Enghard P, Schröder T, Hasper D, Kühnle Y, Jörres A, Storm C. Weak diagnostic performance of troponin, creatine kinase and creatine kinase-MB to diagnose or exclude myocardial infarction after successful resuscitation. Int J Cardiol 2014; 173:216-21. [PMID: 24636545 DOI: 10.1016/j.ijcard.2014.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 02/19/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the diagnostic accuracy of the cardiac injury markers troponin (TNT), creatine kinase (CK) and creatine kinase-MB (CK-MB) to diagnose or exclude acute myocardial infarction after cardiac arrest. METHODS 226 patients who underwent diagnostic coronary angiography after sudden cardiac arrest were analyzed retrospectively. Levels of TNT, CK and CK-MB on admission and 6h, 24h and 36 h later were retrieved from the files and compared with the results of coronary angiography. RESULTS Acute myocardial infarction (AMI) as well as non-AMI patients showed increasing levels of TNT and CK after resuscitation, although the AMI group showed significantly higher TNT and CK levels. Receiver operator curves were calculated to determine the diagnostic precision of TNT, CK and CK-MB to differentiate AMI and non-AMI patients. All analyzed markers yielded mediocre diagnostic precision with an area under the ROC curve of 0.7020, 0.6802 and 0.6508 for 6h TNT, CK and CK-MB, respectively. Applying a modified cut-off of 1 μg/l the 6h TNT measurement had a sensitivity of 70.9% and specificity of 61.2% to diagnose AMI after cardiac arrest. Using CK 800 U/l as cut-off level resulted in a sensitivity of 62.5% and specificity of 73.7%, CK-MB levels higher than 100 U/l yielded a sensitivity of 58.8% and specificity of 72.7%. CONCLUSION Cardiac injury markers cannot be used to reliably diagnose or rule out AMI after resuscitation. Consequently we propose that indication for coronary angiography should be extended to all patients without a certain alternative diagnosis explaining the occurrence of cardiac arrest.
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Affiliation(s)
- Jan M Kruse
- Abteilung für Nephrologie und Internistische Intensivemdizin, Charité Universitätsmedizin Berlin, Germany.
| | - Philipp Enghard
- Abteilung für Nephrologie und Internistische Intensivemdizin, Charité Universitätsmedizin Berlin, Germany
| | - Tim Schröder
- Abteilung für Nephrologie und Internistische Intensivemdizin, Charité Universitätsmedizin Berlin, Germany
| | - Dietrich Hasper
- Abteilung für Nephrologie und Internistische Intensivemdizin, Charité Universitätsmedizin Berlin, Germany
| | - York Kühnle
- Abteilung für Kardiologie, Charité Universitätsmedizin Berlin, Germany
| | - Achim Jörres
- Abteilung für Nephrologie und Internistische Intensivemdizin, Charité Universitätsmedizin Berlin, Germany
| | - Christian Storm
- Abteilung für Nephrologie und Internistische Intensivemdizin, Charité Universitätsmedizin Berlin, Germany
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Kruse JM, Ereshefsky L, Scavone M. Treatment of lithium-induced tremor with nadolol. Clin Pharm 1984; 3:299-301. [PMID: 6145536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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