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Dubey L, Dorosh O, Dubey N, Doan S, Kozishkurt O, Duzenko O, Kozlova O, Ievtukh V, Ladny JR, Pruc M, Szarpak L, Pukach J. COVID-19-induced coagulopathy: Experience, achievements, prospects. Cardiol J 2023:VM/OJS/J/92002. [PMID: 36588310 DOI: 10.5603/cj.a2022.0123] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 01/03/2023] Open
Abstract
The presence of coagulopathy as part of the systemic inflammatory response syndrome is a characteristic feature of severe coronavirus disease 2019 (COVID-19). Hematological changes (increased DD-dimer, prolonged activated partial thromboplastin clotting time [APTT] and prothrombin time [PT], high fibrinogen levels) have been observed in hospitalized patients with COVID-19, which characterize the risk of thrombotic events. Against the background of COVID-19 there is endothelial dysfunction, hypoxia and pulmonary congestion, mediated by thrombosis and microvascular occlusion. Up to 71.4% of patients who died from COVID-19 had disseminated intravascular coagulation syndrome, compared with only 0.6% of survivors. The main manifestation of COVID-19-associated coagulopathy is a significant increase in DD without a decrease in platelet count or prolongation of APTT and PT, indicating increased thrombin formation and the development of local fibrinolysis. An increase in DD levels of more than 3-4 times was associated with higher in-hospital mortality. Therefore, COVID-19 requires assessment of the severity of the disease for further tactics of thromboprophylaxis. The need for continued thromboprophylaxis, or therapeutic anticoagulation, in patients after inpatient treatment for two weeks using imaging techniques to assess of thrombosis assessment.
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Affiliation(s)
- Leonid Dubey
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Olga Dorosh
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.,ENT "Western Ukrainian Specialized Children's Medical Center", Lviv, Ukraine
| | - Nataliya Dubey
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Svitlana Doan
- International European University, Kyiv, Ukraine.,National Medical University of Odessa, Ukraine
| | | | | | - Olena Kozlova
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.,ENT "Western Ukrainian Specialized Children's Medical Center", Lviv, Ukraine
| | | | - Jerzy R Ladny
- Medical University of Bialystok, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Michal Pruc
- Polish Society of Disaster Medicine, Warsaw, Poland
| | | | - Julia Pukach
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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2
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Safiejko K, Smereka J, Pruc M, Ladny JR, Jaguszewski MJ, Filipiak KJ, Yakubtsevich R, Szarpak L. Efficacy and safety of hypertonic saline solutions fluid resuscitation on hypovolemic shock: A systematic review and meta-analysis of randomized controlled trials. Cardiol J 2022; 29:966-977. [PMID: 33140397 PMCID: PMC9788734 DOI: 10.5603/cj.a2020.0134] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Fluid resuscitation is a fundamental intervention in patients with hypovolemic shock resulting from trauma. Appropriate fluid resuscitation in trauma patients could reduce organ failure, until blood components are available, and hemorrhage is controlled. We conducted a systematic review and meta-analysis assessing the effect of hypertonic saline/dextran or hypertonic saline for fluid resuscitation on patient outcomes restricted to adults with hypovolemic shock. METHODS We conducted a search of electronic information sources, including PubMed, Embase, Web of Science, Cochrane library and bibliographic reference lists to identify all randomized controlled trials (RCTs) investigating outcomes of crystalloids versus colloids in patients with hypovolemic shock. We calculated the risk ratio (RR) or mean difference (MD) of groups using fixed or random-effect models. RESULTS Fifteen studies including 3264 patients met our inclusion criteria. Survival to hospital discharge rate between research groups varied and amounted to 71.2% in hypertonic saline/dextran group vs. 68.4% for isotonic/normotonic fluid (normal saline) solutions (odds ratio [OR] = 1.19; 95% confidence interval [CI] 0.97-1.45; I2 = 48%; p = 0.09). 28- to 30-days survival rate for hypertonic fluid solutions was 72.8% survivable, while in the case of isotonic fluid (normal saline) - 71.4% (OR = 1.13; 95% CI 0.75-1.70; I2 = 43%; p = 0.56). CONCLUSIONS This systematic review and meta-analysis, which included only evidence from RCTs hypertonic saline/dextran or hypertonic saline compared with isotonic fluid did not result in superior 28- to 30-day survival as well as in survival to hospital discharge. However, patients with hypotension who received resuscitation with hypertonic saline/dextran had less overall mortality as patients who received conventional fluid.
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Affiliation(s)
- Kamil Safiejko
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Michal Pruc
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jerzy R. Ladny
- Polish Society of Disaster Medicine, Warsaw, Poland,Clinic of Emergency Medicine and Disaster, Medical University Bialystok, Poland
| | | | | | - Ruslan Yakubtsevich
- Department of Anesthesiology and Intensive Care, Grodno State Medical University, Grodno, Belarus
| | - Lukasz Szarpak
- Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland,Polish Society of Disaster Medicine, Warsaw, Poland,Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
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3
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Matuszewski M, Szarpak L, Rafique Z, Peacock FW, Pruc M, Szwed P, Chirico F, Navolokina A, Ladny JR, Denegri A. Prediction Value of KREBS Von Den Lungen-6 (KL-6) Biomarker in COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11216600. [PMID: 36362828 PMCID: PMC9658915 DOI: 10.3390/jcm11216600] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/02/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was performed on Web of Science, PubMed, Scopus and Cochrane Central Register of Controlled Trials databases from 1 January 2020 up to 2 August 2022. The electronic database search was supplemented by searching Google Scholar. In addition, reference lists of relative articles were also reviewed. KL-6 levels among COVID-19 positive vs. negative patients varied and amounted to 443.37 ± 249.33 vs. 205.73 ± 86.8 U/mL (MD = 275.33; 95%CI: 144.57 to 406.09; p < 0.001). The KL-6 level was 402.82 ± 261.16 U/mL in the severe group and was statistically significantly higher than in the non-severe group (297.38 ± 90.46 U/mL; MD = 192.45; 95%CI: 118.19 to 266.72; p < 0.001). The KL-6 level in the mild group was 272.28 ± 95.42 U/mL, compared to 268.04 ± 55.04 U/mL in the moderate COVID-19 group (MD = −12.58; 95%CI: −21.59 to −3.57; p = 0.006). Our meta-analysis indicates a significant association between increased KL-6 levels and SARS-CoV-2 infection. Moreover, KL-6 levels are significantly higher in patients with a more severe course of COVID-19, indicating that KL-6 may be a useful predictor to identify patients at risk for severe COVID-19.
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Affiliation(s)
- Michal Matuszewski
- Department of Anaesthesiology and Intensive Therapy at the Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
- Correspondence:
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Piotr Szwed
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Francesco Chirico
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Health Service Department, Italian State Police, Ministry of the Interior, 20121 Milan, Italy
| | - Alla Navolokina
- Department of Public Health and Social Medicine, International European University, 03187 Kyiv, Ukraine
| | - Jerzy R. Ladny
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
- Department of Emergency Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41121 Modena, Italy
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4
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Olczak-Pruc M, Swieczkowski D, Ladny JR, Pruc M, Juarez-Vela R, Rafique Z, Peacock FW, Szarpak L. Vitamin C Supplementation for the Treatment of COVID-19: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14194217. [PMID: 36235869 PMCID: PMC9570769 DOI: 10.3390/nu14194217] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/23/2022] Open
Abstract
Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe respiratory syndrome coronavirus 2 (SARS-CoV-2), millions of people have died, and the medical system has faced significant difficulties. Our purpose was to perform a meta-analysis to estimate the effect of vitamin C on in-hospital mortality and the ICU or hospital length of stay for patients diagnosed with COVID-19. We conducted a systematic review with meta-analysis in the following databases: PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials. We included studies that evaluated the effect of vitamin C supplementation, compared with standard treatment in COVID-19 patients who are ≥18 y of age. Nineteen trials were included in the meta-analysis. In-hospital mortality with and without vitamin C supplementation was 24.1% vs. 33.9% (OR = 0.59; 95%CI: 0.37 to 0.95; p = 0.03), respectively. Sub-analysis showed that, in randomized clinical trials, in-hospital mortality varied and amounted to 23.9% vs. 35.8% (OR = 0.44; 95%CI: 0.25 to 0.76; p = 0.003), respectively. In the non-randomized trials, in-hospital mortality was 24.2% vs. 33.5% (OR = 0.72; 95%CI: 0.38 to 1.39; p = 0.33), respectively. The ICU length of stay was longer in patients treated with vitamin C vs. standard therapy, 11.1 (7.3) vs. 8.3 (4.7) days (MD = 1.91; 95%CI: 0.89 to 2.93; p < 0.001), respectively. Acute kidney injury in patients treated with and without vitamin C varied and amounted to 27.8% vs. 45.0% (OR = 0.56; 95%CI: 0.40 to 0.78; p < 0.001), respectively. There were no differences in the frequency of other adverse events among patients’ treatment with and without vitamin C (all p > 0.05). The use of vitamin C reduces hospital mortality. The length of stay in the ICU is longer among patients treated with vitamin C. In terms of patient safety, vitamin C has an acceptable profile. Low doses of vitamin C are effective and safe. Despite some evidence of the usefulness of vitamin C in modifying the course of COVID-19, it is too early to modify guidelines and recommendations. Further studies, in particular randomized clinical trials, are necessary.
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Affiliation(s)
| | - Damian Swieczkowski
- Department of Toxicology, Faculty of Pharmacy, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Jerzy R. Ladny
- Department of Emergency Medicine, Medical University of Bialystok, 15-089 Bialystok, Poland
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, 05-806 Warsaw, Poland
| | - Raul Juarez-Vela
- Faculty of Health Science, University of La Rioja, Logroño, 26006 La Rioja, Spain
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Frank W. Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland
- Correspondence: or ; Tel.: +48-50-0186-225
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5
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Nieborek A, Ladny JR, Jaguszewski MJ, Denegri A, Sikora A, Pucylo S, Gasecka A, Pruc M, Savytsky I, Szarpak L. Should targeted temperature management be used in cardiogenic shock patients? Systematic review and meta-analysis. Cardiol J 2022:VM/OJS/J/91254. [PMID: 36200546 DOI: 10.5603/cj.a2022.0093] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Therapeutic hypothermia, or targeted temperature management (TTM), is a strategy of reducing the core body temperature of survivors of sudden cardiac arrest, cardiogenic shock (CS) or stroke. Therefore, a systematic literature review and meta-analysis were performed to tackle the question about whether the implementation of TTM is actually beneficial for patients with CS. METHODS Study was designed as a systematic review and meta-analysis. PubMed, Cochrane Library, Web of Science and Scopus were searched from these databases inception to July 17, 2022. Eligible studies were those comparing TTM and non-TTM treatment in CS patients. Data were pooled with the Mantel-Haenszel method. RESULTS Thirty-day mortality was reported in 3 studies. Polled analysis of 30-day mortality was 44.2% for TTM group and 48.9% for non-TTM group (risk ratio: 0.90; 95% confidence interval: 0.75 to 1.08; p = 0.27). Other mortality follow-up periods showed also no statistically significant differences (p > 0.05). The occurrence of adverse events in the studied groups also did not show statistically significant differences between TTM and non-TTM groups (p > 0.05 for myocardial infarction, stent thrombosis, sepsis, pneumonia, stroke or bleeding events). CONCLUSIONS The present analysis shows no significant benefit of TTM in patients with CS. Moreover, no statistically significant increase of the incidence of adverse effects was found. However, further randomized studies with higher sample size and greater validity are needed to determine if TTM is worth implementing in CS patients.
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Affiliation(s)
- Adam Nieborek
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University Bialystok, Poland
| | | | - Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Italy
| | - Aleksandra Sikora
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Szymon Pucylo
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Ivan Savytsky
- European School of Medicine, International European University, Kyiv, Ukraine
| | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States.
- Reseach Unit, Maria Sklodowska-Curie Bialysok Oncology Center, Bialystok, Poland.
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6
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Blek N, Szwed P, Putowska P, Nowicka A, Drela WL, Gasecka A, Ladny JR, Merza Y, Jaguszewski MJ, Szarpak L. The diagnostic and prognostic value of copeptin in patients with acute ischemic stroke and transient ischemic attack: A systematic review and meta-analysis. Cardiol J 2022; 29:610-618. [PMID: 35621091 PMCID: PMC9273240 DOI: 10.5603/cj.a2022.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/08/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Stroke is the second main cause of mortality and the third leading cause of mortality and permanent disability combined. Many potential biomarkers have been described to contribute to the diagnosis, prognosis of outcomes, and risk stratification after stroke. Copeptin is an inactive peptide that is produced in an equimolar ratio to arginine vasopressin in response to the activation of the endogenous stress system. Methods The present study is a systematic review and meta-analysis to assess plasma copeptin concentrations, diagnostic and prognostic values for risk stratification after acute ischemic stroke and transient ischemic attack. Results Mean copeptin level in stroke vs. non-stroke groups varied and amounted to 19.8 ± 17.4 vs. 9.7 ± 6.6 pmol/L, respectively (mean differences [MD]: 12.75; 95% confidence interval [CI]: 5.00 to 20.49; p < 0.001), in good vs. poor outcome 12.0 ± 3.6 vs. 29.4 ± 14.5 (MD: −8.13; 95% CI: −8.37 to −7.88; p < 0.001) and in survive vs. non-survive stroke patients: 13.4 ± 3.2 vs. 33.0 ± 12.3, respectively (MD: −13.43; 95% CI: −17.82 to −9.05; p < 0.001). Conclusions The above systematic review and meta-analysis suggests that monitoring the copeptin levels may help predict the long-term prognosis of ischemic stroke efficiently. Determining the copeptin level may help individualize the management of ischemic stroke patients, keep stroke risk lower, reduce post-stroke complications, including patient death, and minimize healthcare costs.
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Affiliation(s)
- Natasza Blek
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland. .,Department of Neurology, Wolski Hospital, Warsaw, Poland.
| | - Piotr Szwed
- Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Paulina Putowska
- Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Adrianna Nowicka
- Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Wiktoria L Drela
- Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Aleksandra Gasecka
- Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Jerzy R Ladny
- Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland
| | | | | | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.,Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland.,Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
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7
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Karbowska E, Swieczkowski D, Gasecka A, Pruc M, Safiejko K, Ladny JR, Kopiec T, Jaguszewski MJ, Filipiak KJ, Rafique Z, Szarpak L. Statins and the risk of pancreatic cancer: A systematic review and meta-analysis of 2,797,186 patients. Cardiol J 2022:VM/OJS/J/88590. [PMID: 35373328 DOI: 10.5603/cj.a2022.0014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Statin use in many studies is related to the improvement of a patients' condition including reducing the risk of various malignancies. Herein, is a systematic review and meta-analysis to examine the evidence on the association between statin therapy and the risk of the occurrence of pancreatic cancer, mainly in terms of decreased risk of developing pancreatic cancer among patients using statin therapy in the long-term perspective. METHODS PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database inception to December 1st, 2021. Random effect models were used to estimate summary odds ratios (OR) and the corresponding 95% confidence intervals (CI). RESULTS A total of 26 studies comprising 2,797,186 patients were included. Polled analysis showed that pancreatic cancer occurrence in statin vs. no-statin group varied and amounted to 0.4% vs. 0.6% (RR = 0.83; 95% CI: 0.72-0.96; I² = 84%; p = 0.01). CONCLUSIONS In summary, the present analysis shows that overall statins use is significantly associated with a reduction in risk of pancreatic cancer. However, these results were not confirmed for the randomized controlled trial subgroup. Further prospective studies are needed to confirm the current results.
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Affiliation(s)
- Eryka Karbowska
- Department of CT and MR Radiology, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Damian Swieczkowski
- Department of Toxicology, Faculty of Pharmacy, Medical University of Gdansk, Gdańsk, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | - Michal Pruc
- Research Unit, Polish Soceity of Disaster Medicine, Warsaw, Poland
| | - Kamil Safiejko
- Colorectal Cancer Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Jerzy R Ladny
- Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Tomasz Kopiec
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Krzysztof J Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA;.
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Szarpak L, Peacock FW, Rafique Z, Ladny JR, Nadolny K, Malysz M, Dabrowski M, Chirico F, Smereka J. Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment. Am J Emerg Med 2022; 53:122-126. [PMID: 35016094 PMCID: PMC8731221 DOI: 10.1016/j.ajem.2021.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/30/2021] [Revised: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). Methods Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. Results We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43–92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of −48 s (95%CI confidence interval [CI], −60.23, −35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). Conclusions The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. Trial registration: ClinicalTrials registration number NCT04365608
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Affiliation(s)
- Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland; Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Frank W Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jerzy R Ladny
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Department Emergency Medicine, University Medicine of Białystok, Bialystok, Poland
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland
| | - Marek Malysz
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland; Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marek Dabrowski
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Francesco Chirico
- Post-graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy; Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy
| | - Jacek Smereka
- Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland; Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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9
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Robak O, Dudek M, Ladny JR, Szarpak L, Gilis-Malinowska N, Frass M. Cardiac tamponade as a cause of COVID-19. Cardiol J 2021; 27:900-901. [PMID: 33432570 DOI: 10.5603/cj.2020.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maciej Dudek
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jerzy R Ladny
- Polish Society of Disaster Medicine, Warsaw, Poland.,Chair of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Lukasz Szarpak
- Polish Society of Disaster Medicine, Warsaw, Poland. .,Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland. .,Maria Sklodowska-Curie Bialystok Oncology Centre, Bialystok, Poland.
| | | | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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10
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Szarpak L, Zaczynski A, Kosior D, Bialka S, Ladny JR, Gilis-Malinowska N, Smereka J, Kanczuga-Koda L, Gasecka A, Filipiak KJ, Jaguszewski MJ. Evidence of diagnostic value of ferritin in patients with COVID-19. Cardiol J 2020; 27:886-887. [PMID: 33346371 DOI: 10.5603/cj.a2020.0171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Maria Skłodowska-Curie Medical Academy in Warsaw, Poland. .,Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland.. .,Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland..
| | - Artur Zaczynski
- Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
| | - Dariusz Kosior
- Department of Cardiology and Hypertension with Electrophysiological Lab, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland.,Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Szymon Bialka
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Jerzy R Ladny
- Polish Society of Disaster Medicine, Warsaw, Poland.,Chair of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | | | - Jacek Smereka
- Polish Society of Disaster Medicine, Warsaw, Poland.,Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | | | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland
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11
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Safiejko K, Smereka J, Filipiak KJ, Szarpak A, Dabrowski M, Ladny JR, Jaguszewski MJ, Szarpak L. Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials. Cardiol J 2020; 29:463-471. [PMID: 32648249 PMCID: PMC9170316 DOI: 10.5603/cj.a2020.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although the resuscitation of an adult trauma patient has been researched and written about for the past century, the ideal fluid strategy to infuse during the initial resuscitation period remains unresolved. This work was aimed at assessing the effect of hypotensive versus conventional resuscitation strategies in traumatic hemorrhagic shock patients on mortality, and the need for blood transfusions including adverse events. METHODS This systematic review and meta-analysis were performed following the PRISMA guidelines. Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of hypotension versus conventional fluid resuscitation for traumatic hemorrhagic shock patients. Two reviewers independently performed the screening, data extraction, and bias assessment. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.4. RESULTS Data from 28 RCTs on 4503 patients were included in the final meta-analysis. Patients receiving hypotension fluid resuscitation compared with conventional fluid resuscitation experienced less mortality (12.5% vs. 21.4%; RR = 0.58; 95% CI: 0.51-0.66; p < 0.001), fewer adverse events (10.8% vs. 13.4%; RR = 0.70; 95% CI: 0.59-0.83; p < 0.001), including fever acute respiratory distress syndrome (7.8% vs. 16.8%) or multiple organ dysfunction syndrome (8.6% vs. 21.6%). CONCLUSIONS This meta-analysis showed that hypotensive fluid resuscitation significantly reduced the mortality of hypovolemic shock patients. Findings are low in certainty and should be interpreted with caution. Therefore, there is an urgent need for larger, multicenter, randomized trials to confirm these findings.
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Affiliation(s)
- Kamil Safiejko
- Comprehensive Cancer Center in Bialystok, Bialystok, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Krzysztof J Filipiak
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Szarpak
- Maria Skłodowska-Curie Madical Academy in Warsaw, Warsaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marek Dabrowski
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland; Polish Society of Disaster Medicine, Warsaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
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12
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Szarpak L, Ruetzler K, Dabrowski M, Nadolny K, Ladny JR, Smereka J, Jaguszewski M, Filipiak KJ. Dilemmas in resuscitation of COVID-19 patients based on current evidence. Cardiol J 2020; 27:327-328. [PMID: 32419130 DOI: 10.5603/cj.a2020.0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Marek Dabrowski
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland, Dabrowa Gornicza, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland; Polish Society of Disaster Medicine, Warsaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Milosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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13
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Malysz M, Dabrowski M, Böttiger BW, Smereka J, Kulak K, Szarpak A, Jaguszewski M, Filipiak KJ, Ladny JR, Ruetzler K, Szarpak L. Resuscitation of the patient with suspected/confirmed COVID-19 when wearing personal protective equipment: A randomized multicenter crossover simulation trial. Cardiol J 2020; 27:497-506. [PMID: 32419128 DOI: 10.5603/cj.a2020.0068] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 04/06/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP). METHODS This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures. RESULTS The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38-45) vs. 45 (40-50) vs. 51 (50-52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102-131) compressions per minute (CPM) for manual CC, 107 (105-127) CPM for CPRMeter, and 102 (101-102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM - 100% (95-100), 80% (60-90) in CPRMeter group, and the lowest for manual CC - 29% (26-48). CONCLUSIONS According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP.
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Affiliation(s)
- Marek Malysz
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Marek Dabrowski
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Köln, Germany
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | | | | | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof J Filipiak
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Kurt Ruetzler
- Departments of General Anesthesiology and Outcomes Research, Cleveland Clinic, Anesthesiology Institute, Cleveland, OH, USA
| | - Lukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Polish Society of Disaster Medicine, Warsaw, Poland.
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14
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Smereka J, Szarpak L, Filipiak KJ, Jaguszewski M, Ladny JR. Which intravascular access should we use in patients with suspected/confirmed COVID-19? Resuscitation 2020; 151:8-9. [PMID: 32304800 PMCID: PMC7158769 DOI: 10.1016/j.resuscitation.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Polish Society of Disaster Medicine, Wroclaw, Poland
| | - Lukasz Szarpak
- Lazarski University, Warsaw, Poland, Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Krzysztof J Filipiak
- First Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University of Bialystok, Polish Society of Disaster Medicine, Bialystok, Poland
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15
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Smereka J, Puslecki M, Ruetzler K, Filipiak KJ, Jaguszewski M, Ladny JR, Szarpak L. Extracorporeal membrane oxygenation in COVID-19. Cardiol J 2020; 27:216-217. [PMID: 32285929 DOI: 10.5603/cj.a2020.0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Mateusz Puslecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kurt Ruetzler
- Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland, Warsaw
| | | | - Jerzy R Ladny
- Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | - Lukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Polish Society of Disaster Medicine, Warsaw, Poland.
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16
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Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27:218-219. [PMID: 32285928 DOI: 10.5603/cj.a2020.0054] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
| | | | - Jerzy R Ladny
- Department of Emergency Medicine, Medical University of Bialystok, Poland.,Polish Society of Disaster Medicine, Warsaw, Poland
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17
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Dzieciatkowski T, Szarpak L, Filipiak KJ, Jaguszewski M, Ladny JR, Smereka J. COVID-19 challenge for modern medicine. Cardiol J 2020; 27:175-183. [PMID: 32286679 PMCID: PMC8016041 DOI: 10.5603/cj.a2020.0055] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 04/06/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
Coronaviruses cause disease in animals and people around the world. Human coronaviruses (HCoV) are mainly known to cause infections of the upper and lower respiratory tract but the symptoms may also involve the nervous and digestive systems. Since the beginning of December 2019, there has been an epidemic of SARS-CoV-2, which was originally referred to as 2019-nCoV. The most common symptoms are fever and cough, fatigue, sputum production, dyspnea, myalgia, arthralgia or sore throat, headache, nausea, vomiting or diarrhea (30%). The best prevention is to avoid exposure. In addition, contact per-sons should be subjected to mandatory quarantine. COVID-19 patients should be treated in specialist centers. A significant number of patients with pneumonia require passive oxygen therapy. Non-invasive ventilation and high-flow nasal oxygen therapy can be applied in mild and moderate non-hypercapnia cases. A lung-saving ventilation strategy must be implemented in acute respiratory distress syndrome and mechanically ventilated patients. Extracorporeal membrane oxygenation is a highly specialized method, available only in selected centers and not applicable to a significant number of cases. Specific pharmacological treatment for COVID-19 is not currently available. Modern medicine is gearing up to fight the new coronavirus pandemic. The key is a holistic approach to the patient including, primar-ily, the use of personal protective equipment to reduce the risk of further virus transmission, as well as patient management, which consists in both quarantine and, in the absence of specific pharmacological therapy, symptomatic treatment.
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Affiliation(s)
- Tomasz Dzieciatkowski
- Chair and Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland, Warsaw
| | - Milosz Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy R Ladny
- Clinic of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
- Polish Society of Disaster Medicine, Warsaw, Poland
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18
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Szarpak L, Filipiak KJ, Mosteller L, Jaguszewski M, Smereka J, Ruetzler K, Ahuja S, Ladny JR. Survival, neurological and safety outcomes after out of hospital cardiac arrests treated by using prehospital therapeutic hypothermia: A systematic review and meta-analysis. Am J Emerg Med 2020; 42:168-177. [PMID: 32088060 DOI: 10.1016/j.ajem.2020.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/17/2020] [Accepted: 02/13/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Lazarski University, Warsaw, Poland; Polish Society of Disaster Medicine, Warsaw, Poland.
| | | | - Lauretta Mosteller
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Kurt Ruetzler
- Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
| | - Sanchit Ahuja
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, Michigan & Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
| | - Jerzy R Ladny
- Department of Emergency Medicine, Medical University of Bialystok, Bialystok, Poland
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19
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Szarpak L, Smereka J, Ladny JR, Ruetzler K. The thumbs angle used in the novel infant chest compression technique (new two-thumb technique, nTTT) can influence the quality parameters of resuscitation. Med Intensiva 2018; 43:387. [PMID: 30482558 DOI: 10.1016/j.medin.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/30/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - J Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
| | - J R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - K Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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20
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Bielski A, Rivas E, Ruetzler K, Smereka J, Puslecki M, Dabrowski M, Ladny JR, Frass M, Robak O, Evrin T, Szarpak L. Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand: Randomized, crossover manikin trial. Medicine (Baltimore) 2018; 97:e12593. [PMID: 30290627 PMCID: PMC6200544 DOI: 10.1097/md.0000000000012593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation. METHODS The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression. RESULTS Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35-49), compared with Air-Q (21 seconds, 18-32) and I-Gel (19 seconds, 17-27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001). CONCLUSIONS Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.
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Affiliation(s)
| | - Eva Rivas
- Department of Anesthesiology, Hospital Clinic, IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
- Department of OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kurt Ruetzler
- Department of OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw
| | - Mateusz Puslecki
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Marek Dabrowski
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Togay Evrin
- Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
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21
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Ladny M, Szarpak L, Smereka J, Ladny JR. A comparison of comfort assessment of NECKLITE vs. NeXsplint cervical collar. Pilot data. Am J Emerg Med 2018; 36:2127-2128. [PMID: 29752163 DOI: 10.1016/j.ajem.2018.03.078] [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] [Received: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Michal Ladny
- Department of Trauma-Orthopedic Surgery, Solec Hospital, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
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22
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Ladny JR, Smereka J, Rodríguez-Núñez A, Leung S, Ruetzler K, Szarpak L. Is there any alternative to standard chest compression techniques in infants? A randomized manikin trial of the new "2-thumb-fist" option. Medicine (Baltimore) 2018; 97:e9386. [PMID: 29384839 PMCID: PMC5805411 DOI: 10.1097/md.0000000000009386] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pediatric cardiac arrest is a fatal emergent condition that is associated with high mortality, permanent neurological injury, and is a socioeconomic burden at both the individual and national levels. The aim of this study was to test in an infant manikin a new chest compression (CC) technique ("2 thumbs-fist" or nTTT) in comparison with standard 2-finger (TFT) and 2-thumb-encircling hands techniques (TTEHT). METHODS This was prospective, randomized, crossover manikin study. Sixty-three nurses who performed a randomized sequence of 2-minute continuous CC with the 3 techniques in random order. Simulated systolic (SBP), diastolic (DBP), mean arterial pressure (MAP), and pulse pressures (PP, SBP-DBP) in mm Hg were measured. RESULTS The nTTT resulted in a higher median SBP value (69 [IQR, 63-74] mm Hg) than TTEHT (41.5 [IQR, 39-42] mm Hg), (P < .001) and TFT (26.5 [IQR, 25.5-29] mm Hg), (P <.001). The simulated median value of DBP was 20 (IQR, 19-20) mm Hg with nTTT, 18 (IQR, 17-19) mm Hg with TTEHT and 23.5 (IQR, 22-25.5) mm Hg with TFT. DBP was significantly higher with TFT than with TTEHT (P <.001), as well as with TTEHT than nTTT (P <.001). Median values of simulated MAP were 37 (IQR, 34.5-38) mm Hg with nTTT, 26 (IQR, 25-26) mm Hg with TTEHT and 24.5 (IQR,23.5-26.5) mm Hg with TFT. A statistically significant difference was noticed between nTTT and TFT (P <.001), nTTT and TTEHT (P <.001), and between TTEHT and TFT (P <.001). Sixty-one subjects (96.8%) preferred the nTTT over the 2 standard methods. CONCLUSIONS The new nTTT technique achieved higher SBP and MAP compared to the standard CC techniques in our infant manikin model. nTTT appears to be a suitable alternative or complementary to the TFT and TTEHT.
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Affiliation(s)
- Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Antonio Rodríguez-Núñez
- Clinursid Research Group, School of Nursing, University of Santiago de Compostela
- Institute of Research of Santiago (IDIS)
- Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, SERGAS, Santiago de Compostela
- SAMID-II Network, Madrid, Spain
| | - Steve Leung
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
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Smereka J, Szarpak L, Ladny JR, Rodriguez-Nunez A, Ruetzler K. A Novel Method of Newborn Chest Compression: A Randomized Crossover Simulation Study. Front Pediatr 2018; 6:159. [PMID: 29896467 PMCID: PMC5986950 DOI: 10.3389/fped.2018.00159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/10/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To compare a novel two-thumb chest compression technique with standard techniques during newborn resuscitation performed by novice physicians in terms of median depth of chest compressions, degree of full chest recoil, and effective compression efficacy. Patients and Methods: The total of 74 novice physicians with less than 1-year work experience participated in the study. They performed chest compressions using three techniques: (A) The new two-thumb technique (nTTT). The novel method of chest compressions in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. (B) TFT. With this method, the rescuer compresses the sternum with the tips of two fingers. (C) TTHT. Two thumbs are placed over the lower third of the sternum, with the fingers encircling the torso and supporting the back. Results: The median depth of chest compressions for nTTT was 3.8 (IQR, 3.7-3.9) cm, for TFT-2.1 (IQR, 1.7-2.5) cm, while for TTHT-3.6 (IQR, 3.5-3.8) cm. There was a significant difference between nTTT and TFT, and TTHT and TFT (p < 0.001) for each time interval during resuscitation. The degree of full chest recoil was 93% (IQR, 91-97) for nTTT, 99% (IQR, 96-100) for TFT, and 90% (IQR, 74-91) for TTHT. There was a statistically significant difference in the degree of complete chest relaxation between nTTT and TFT (p < 0.001), between nTTT and TTHT (p = 0.016), and between TFT and TTHT (p < 0.001). Conclusion: The median chest compression depth for nTTT and TTHT is significantly higher than that for TFT. The degree of full chest recoil was highest for TFT, then for nTTT and TTHT. The effective compression efficiency with nTTT was higher than for TTHT and TFT. Our novel newborn chest compression method in this manikin study provided adequate chest compression depth and degree of full chest recoil, as well as very good effective compression efficiency. Further clinical studies are necessary to confirm these initial results.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wrocław Medical University, >Wrocław, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw , Warsaw, Poland.,Department of Emergency Medicine and Disaster, Medical University of Białystok, Białystok, Poland
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University of Białystok, Białystok, Poland
| | - Antonio Rodriguez-Nunez
- Clinursid Research Group, School of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States
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Wieczorek W, Smereka J, Ladny JR, Kaminska H, Galazkowski R, Szarpak L. The impact of a CPRezy™ feedback device on the quality of chest compressions performed by nurses. Am J Emerg Med 2017; 36:1318-1319. [PMID: 29196113 DOI: 10.1016/j.ajem.2017.11.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/19/2017] [Accepted: 11/27/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Wojciech Wieczorek
- Department of Anaesthesiology, Intensive Care and Emergency Medicine in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Halla Kaminska
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
| | - Robert Galazkowski
- Department of Emergency Medical Service, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland; Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
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Smereka J, Ladny JR, Szarpak L. Comparison of the Intubrite and Macintosh laryngoscopes in a difficult airway scenario. Am J Emerg Med 2017; 35:925. [DOI: 10.1016/j.ajem.2017.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/29/2022] Open
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Smereka J, Czyzewski L, Szarpak L, Ladny JR. Comparison between the TrueView EVO2 PCD and direct laryngoscopy for endotracheal intubation performed by paramedics: Preliminary data. Am J Emerg Med 2017; 35:789-790. [DOI: 10.1016/j.ajem.2016.11.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022] Open
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Bielski K, Smereka J, Ladny JR, Szarpak L. A comparison of the Macintosh laryngoscope and blind intubation via I-gel in intubating an entrapped patient: A randomized crossover manikin study. Am J Emerg Med 2017; 35:787-789. [DOI: 10.1016/j.ajem.2016.11.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022] Open
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Smereka J, Szarpak L, Rodríguez-Núñez A, Ladny JR, Leung S, Ruetzler K. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med 2017; 35:1420-1425. [PMID: 28433454 DOI: 10.1016/j.ajem.2017.04.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 01/13/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief. METHODS 42 paramedics from the national Emergency Medical Service of Poland performed three single-rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two-thumb (TTHT), the conventional two-finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10-seconds cycle. RESULTS The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p<.001), nTTT and TTHT (p<0.001), TFT and TTHT (p=0.003). The median diastolic preassure using nTTT was 16 mmHg compared with 9 mmHg for TFT (p<0.001), and 9.5 mmHg for TTHT (p<0.001). Mean arterial pressure using distinct methods varied and amounted to 40 vs. 22. vs. 26 mmHg (nTTT vs. TFT vs. TTHT, respectively). A statistically significant difference was noticed between nTTT and TFT (p<0.001), nTTT and TTEHT (p<0.001), and TFT and TTHT (p<0.001). The highest median pulse pressure was obtained by the nTTT 67.5 mmHg. Pulse pressure was 31.5 mmHg in the TTHT and 24 mmHg in the TFT. The difference between TFT and TTHT (p=0.025), TFT and nTTT (p<0.001), as well as between TTHT and nTTT (p<0.001) were statistically significant. CONCLUSIONS The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Antonio Rodríguez-Núñez
- Paediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Santiago de Compostela, Institute of Research of Santiago [IDIS] and SAMID Network, Spain
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Steve Leung
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
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Abstract
BACKGROUND Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The "new 2-thumb technique" (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, the aim of this study was to compare 3 chest compression techniques, namely, the 2-finger-technique (TFT), the 2-thumb-technique (TTHT), and the nTTT in an randomized infant-CPR manikin setting. METHODS A total of 73 paramedics with at least 1 year of clinical experience performed 3 CPR settings with a chest compression:ventilation ratio of 15:2, according to current guidelines. Chest compression was performed with 1 out of the 3 chest compression techniques in a randomized sequence. Chest compression rate and depth, chest decompression, and adequate ventilation after chest compression served as outcome parameters. RESULTS The chest compression depth was 29 (IQR, 28-29) mm in the TFT group, 42 (40-43) mm in the TTHT group, and 40 (39-40) mm in the nTTT group (TFT vs TTHT, P < 0.001; TFT vs nTTT, P < 0.001; TTHT vs nTTT, P < 0.01). The median compression rate with TFT, TTHT, and nTTT varied and amounted to 136 (IQR, 133-144) min versus 117 (115-121) min versus 111 (109-113) min. There was a statistically significant difference in the compression rate between TFT and TTHT (P < 0.001), TFT and nTTT (P < 0.001), as well as TTHT and nTTT (P < 0.001). Incorrect decompressions after CC were significantly increased in the TTHT group compared with the TFT (P < 0.001) and the nTTT (P < 0.001) group. CONCLUSIONS The nTTT provides adequate chest compression depth and rate and was associated with adequate chest decompression and possibility to adequately ventilate the infant manikin. Further clinical studies are necessary to confirm these initial findings.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University
| | - Karol Bielski
- MEDITRANS The Provincial Emergency Medical Service and Sanitary Transport, Warsaw
| | - Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Kurt Ruetzler
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
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Smereka J, Szarpak L, Ladny JR. The LMA Fastrach® as a conduit for endotracheal intubation during simulated cardiopulmonary resuscitation. Am J Emerg Med 2017; 35:1020-1021. [PMID: 28094082 DOI: 10.1016/j.ajem.2017.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
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Szarpak L, Smereka J, Ladny JR. Comparison of Macintosh and Intubrite laryngoscopes for intubation performed by novice physicians in a difficult airway scenario. Am J Emerg Med 2017; 35:796-797. [PMID: 28139309 DOI: 10.1016/j.ajem.2017.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 01/03/2017] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION In the difficult airway, the intubation skills are critically important. In selected cases, particularly in airway edema, laryngeal or tongue edema, endotracheal intubation can turn out very difficult, and repeated attempts may even worsen the airway edema, causing trauma and bleeding, and finally leading to complete airway obstruction and inability to ventilate the patient. AIM OF THE STUDY The aim of the study was to compare the efficacy of endotracheal intubation performed by novice physicians using a standard Macintosh laryngoscope and an Intubrite videolaryngoscope. MATERIAL AND METHODS The study was designed as a prospective, randomized, crossover, simulation study and continues our research assessing the effectiveness of selected endotracheal intubation techniques in prehospital settings. All participants were experienced with the Macintosh direct laryngoscope but remained novice to videolaryngoscopy. Instructions on the correct use of the Macintosh and Intubrite laryngoscopes were given before the procedure, and all the 30 novice physicians were allowed to practice at least 10 times before the study on manikin with normal airways. We employed an airway manikin (Trucorp Airsim Bronchi; Trucorp Ltd., Belfast, Northern Ireland) to simulate difficult airway, with was obtained by inflating the tongue with 50mL of air. The participants were asked to perform tracheal intubation using an endotracheal tube with 7.5mm of internal diameter (Portex; Smiths Medical, Hythe, UK) through the vocal cords, applying either a conventional Macintosh laryngoscope with a size 3 blade (MAC; Mercury Medical, Clearwater, FL, USA) or the Intubrite videolaryngoscope, also with a Macintosh No. 3 blade (INT; Intubrite Llc, Vista, CA, USA). In both intubation techniques, a guide stylet (Rusch Inc., Duluth, GA, USA) was introduced into the endotracheal tube in order to obtain a C-shape curve to facilitate tracheal intubation. Each participating physician was randomly assigned to three attempts of tracheal intubation with each device. RESULTS The effectiveness of the first intubation attempt using MAC and INT was 63.6% and 53.4%, respectively (p=0.023), and the total percentage of intubation was 100% for both methods. The median time to intubation was 29.5 (interquartile range [IQR], 27-35.5) s with MAC, and 229 (IQR, 25.5-37) s with INT. The total of 24 physicians out of all study participants would choose MAC as a device to intubate with in real terms, while only 6 physicians would choose INT. CONCLUSIONS During the simulation study, the novice physicians were able to perform endotracheal intubation at the same time using both the Macintosh and Intubrite videolaryngoscope. However, the efficacy of the first intubation attempt was higher for MAC. Further studies are needed to confirm the results.
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Affiliation(s)
- Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
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Bielski K, Szarpak L, Smereka J, Ladny JR, Leung S, Ruetzler K. Comparison of four different intraosseous access devices during simulated pediatric resuscitation. A randomized crossover manikin trial. Eur J Pediatr 2017; 176:865-871. [PMID: 28500463 PMCID: PMC5486567 DOI: 10.1007/s00431-017-2922-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED The aim of the study was to compare the success rate, procedure time, and user satisfaction of pediatric NIO™ compared to Pediatric BIG®, EZ-IO®, and Jamshidi intraosseous access devices. This was a randomized, crossover manikin trial with 87 paramedics. The correct location of intraosseous access when using NIO, BIG, EZ-IO, and Jamshidi was varied and was respectively 100, 90, 90, and 90%. The time required to obtain intravascular access (time T1) in the case of NIO, BIG, EZ-IO, and Jamshidi was varied and amounted to 9 s [IQR, 8-12] for NIO, 12 s [IQR, 9-16] for BIG, 13.5 s [IQR, 11-17] for the EZ-IO, and 15 s [IQR, 13-19] for Jamshidi. The paramedics evaluated each device on the subjective ease with which they performed the procedures. The intraosseous device, which proved the easiest to use was NIO, which in the case of CPR received a median rating of 1.5 (IQR, 0.5-1.5) points. CONCLUSION Our study found that NIO® is superior to BIG®, EZ-IO®, and Jamshidi. NIO® achieved the highest first attempt success rate. NIO® also required the least time to insert and easiest to operate even by novice users. Further study is needed to test our findings in cadavers or human subjects. Based on our findings, NIO® is a promising intraosseous device for use in pediatric resuscitation. What is Known: • Venous access in acutely ill pediatric patients, such as those undergoing cardiopulmonary resuscitation, is needed for prompt administration of drugs and fluids. • Intraosseous access is recommended by American Heart Association and European Resuscitation council if vascular access is not readily obtainable to prevent delay in treatment. What is New: • This simulated pediatric resuscitation compared performance of four commercially available pediatric intraosseous devices in a manikin model. • NIO® outperformed BIG®, EZ-IO®, and Jamshidi in first attempt success rates and time of procedure among novice users.
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Affiliation(s)
- Karol Bielski
- MEDITRANS The Voivodship Emergency Medical Service and Sanitary Transport, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Street, 02-005, Warsaw, Poland.
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Steve Leung
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA ,Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH USA
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Ladny JR, Sierzantowicz R, Kedziora J, Szarpak L. Comparison of direct and optical laryngoscopy during simulated cardiopulmonary resuscitation. Am J Emerg Med 2016; 35:518-519. [PMID: 28089239 DOI: 10.1016/j.ajem.2016.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/11/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | | | - Jaroslaw Kedziora
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
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Ladny JR, Smereka J, Szarpak L. Comparison of the Trachway video intubating stylet and Macintosh laryngoscope for endotracheal intubation. Preliminary data. Am J Emerg Med 2016; 35:574-575. [PMID: 27986336 DOI: 10.1016/j.ajem.2016.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
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Ladny JR, Bielski K, Szarpak L, Cieciel M, Konski R, Smereka J. Are nurses able to perform blind intubation? Randomized comparison of I-gel and laryngeal mask airway. Am J Emerg Med 2016; 35:786-787. [PMID: 27899211 DOI: 10.1016/j.ajem.2016.11.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Karol Bielski
- MEDITRANS The Provincial Emergency Medical Service and Sanitary Transport, Warsaw, Poland.
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Michal Cieciel
- Emergency Medicine Student Scientific Circle at Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Roman Konski
- Emergency Medicine Student Scientific Circle at Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
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Hady HR, Sołdatow M, Lukaszewicz J, Luba M, Pierko J, Myśliwiec P, Ladny JR, Dadan J. Surgical treatment of malignant and benign colorectal neoplasms based on authors' clinical data. ADV CLIN EXP MED 2013; 22:219-227. [PMID: 23709378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Colorectal cancer remains a huge diagnostic and therapeutic issue in Poland and worldwide. World epidemiological data indicates a constant increase in morbidity in recent decades. OBJECTIVES The aim of this research was to present surgical procedures in malignant and benign colorectal neoplasms based on authors' clinical data. MATERIAL AND METHODS Between 2001 and 2010, in the 1st Department of General and Endocrinological Surgery in Bialystok, 754 patients with malignant colorectal cancer were hospitalized. Precancerous conditions which included polyps and non-specific bowel inflammations were observed in 491 and 52 patients, respectively. RESULTS The most frequent location of a malignant colorectal tumor was the rectum - 271 (35%) cases and sigmoid colon - 235 (31%) cases. In 8 cases (1%), a multifocal location of colorectal neoplasm was observed. Similar locations were observed in the case of polyps. They were observed the most frequently in the sigmoid colon - 144 (29.3%) cases and rectum - 122 (24.8%) cases. In the cases of colorectal cancer located in the rectum (271), the most frequently applied procedure was abdomino-perineal amputation - 102 (37.6%) patients (T1-3 N1-2 M0). In sigmoid colon cancer (235 cases), sigmoid colon resection was performed most frequently - in 175 patients (74.5%) (T1-3 N0-2 M0-1). Right hemicolectomy was performed in 120 (T1-4 N0-2 M0-1) patients and left hemicolectomy in 52 (T1-4 N02 M0-1) patients. In 482 cases, endoscopic resection of polyps was performed and in 9 patients resection through laparotomy. The majority of operations were performed according to plan, however, many of them were performed in emergency. CONCLUSIONS Colorectal cancers, irrespectively to their location, develop secretly without any symptoms in the early stages which is the reason why patients contact a doctor in the late stadium of the disease. It is also the cause for a majority of the procedures performed in emergency. The best prognosis and long-term results are obtained with treatment combined with radio- and chemotherapy.
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Affiliation(s)
- Hady Razak Hady
- Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland.
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Waszkiewicz N, Zalewska-Szajda B, Szajda SD, Kępka A, Waszkiewicz M, Roszkowska-Jakimiec W, Wojewódzka-Żeleźniakowicz M, Milewska AJ, Dadan J, Szulc A, Zwierz K, Ladny JR. Lysosomal exoglycosidases and cathepsin D in colon adenocarcinoma. Pol Arch Med Wewn 2012; 122:551-556. [PMID: 23111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Changes in the structure of membrane glycoconjugates and activity of glycosidases and proteases are important in tumor formation. OBJECTIVES The aim of the study was to compare the specific activity of lysosomal exoglycosidases: N-acetyl-β-D-hexosaminidase (HEX), its isoenzymes A (HEX A) and B (HEX B), β-D-galactosidase (GAL), α-fucosidase (FUC), and α-mannosidase (MAN) with the activity of cathepsin D (CD) in serum, urine, and carcinoma tissue of patients with colon adenocarcinoma. PATIENTS AND METHODS The specific activity of HEX, HEX A, HEX B, GAL, FUC, MAN, and CD was assayed in serum, urine, and carcinoma tissue of 12 patients with colon adenocarcinoma. RESULTS Lysosomal exoglycosidases and CD have similar specific activity in colon adenocarcinoma tissue and urine, which is higher than their activity in serum (with the exception of the highest specific activity of CD in urine). A positive correlation was observed between the specific activity of CD and that of HEX, HEX A, FUC, and MAN in the carcinoma tissue and urine as well as between CD and GAL in the urine of patients with colon adenocarcinoma. Negative correlations were observed between protein levels and the specific activity of HEX, HEX A, FUC, MAN, and CD in the carcinoma tissue and urine, and between protein levels and GAL in urine. CONCLUSIONS Increased degradation and remodeling of glycoconjugates in the colon adenocarcinoma tissue is reflected by increased specific activity of exoglycosidases and CD. The results suggest a strong effect of exoglycosidase action on tissue degradation and a potential role of exoglycosidases in the initiation of proteolysis.
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38
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Polaków J, Ladny JR, Serwatka W, Walecki J, Puchalski Z, Czech B. Percutaneous fine-needle pancreatic pseudocyst puncture guided by three-dimensional sonography. Hepatogastroenterology 2001; 48:1308-11. [PMID: 11677952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND/AIMS At present a pancreatic pseudocyst puncture guided by ultrasonography is a treatment of choice in the majority of hospitals. A classical two-dimensional sonography is usually implemented in these cases. However, its shortcomings, mainly in differential diagnosis, are acknowledged by most physicians. The real time monitoring of a fine-needle pseudocyst procedure by two-dimensional ultrasonography is of questionable reliability. In our study we evaluated the usefulness of three-dimensional sonography in the percutaneous fine-needle pancreatic pseudocyst puncture. METHODOLOGY We examined fifty-two patients diagnosed as having pancreatic pseudocysts on the basis of clinical symptoms and two-dimensional ultrasonography findings. Then the decision to qualify certain patients for the percutaneous fine-needle aspiration guided by ultrasonography was made on the basis of two- and three-dimensional scan results. The next step in our investigation was to implement color Doppler in order to visualize all blood vessels at the planned biopsy site. Three-dimensional sonography was used to monitor the tip of the needle making its way to the pancreatic pseudocyst and later inside the fluid collection. RESULTS Pancreatic pseudocysts were diagnosed in all of the 52 cases. Three-dimensional sonography was more precise in visualizing the shape and size than two-dimensional ultrasound scans. CONCLUSIONS Three-dimensional presentation can better visualize irregular shapes, local thickenings, and calcification of pseudocyst walls than classical two-dimensional ultrasound scans. The use of subtraction in three-dimensional scans of blood vessels increases the safety in performing biopsies. It makes the aspiration of cytologic materials much safer to perform. In our study we have shown that three-dimensional sonography collects extremely useful information about the status of the pseudocyst structure and it should become a complementary method to classical ultrasonography. This technique when used on a routine basis ought to help us change the inclusion criteria for guided biopsies.
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Affiliation(s)
- J Polaków
- Department of Radiology, 1st Department of General Surgery, Bialystok Medical School, Bialystok 15-230, Poland.
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39
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Pogorzelski G, Mazurkiewicz Z, Ladny JR. [The use of the garamycin sponge in the treatment of infected pseudoarthrosis of the tibia]. Chir Narzadow Ruchu Ortop Pol 2000; 65:191-7. [PMID: 10967834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The use of the Garamycin sponge in the treatment of infected pseudoarthrosis of the tibia has been presented. The study included 6 male patients aged from 27 to 56 years; the sponge filled the defect after resection of the pseudoarthrosis. The method seems to be the one of choice to support adequate surgical intervention grossly contributing to the final positive result.
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Affiliation(s)
- G Pogorzelski
- Oddział Ortopedyczno-Urazowy, Wojewódzki Szpital Zespolony im. J. Sniadeckiego w Białymstoku
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40
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Razak H, Ladny JR, Laszkiewicz J, Trochimowicz L, Róg M, Puchalski Z. [Diagnosis and surgical treatment of pancreatic carcinoma]. Wiad Lek 2000; 52:480-7. [PMID: 10628273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The aim of the study was presentation of our experiences in the diagnostics and treatment of pancreatic carcinoma in confrontation with current opinions. Between 1983 and April 1998 308 patients (198 males and 110 females with mean age 61 years) were treated at our department. In 211 cases tumor was primarily localized in the head and in 97 cases (31.5%) in the body or tail of pancreas. The diagnosis was determined on the basis of clinical symptoms and laboratory investigations. Diagnostic accuracy of performed investigations was as following. Ultrasonography-86%, CT-scan-95%, and ERCP-94%. Ultrasonography or CT guided biopsy and serodiagnostics improved detectability of resectionable carcinoma in the last past years. Among 308 patients, 292 underwent surgery. Since 1997 an intraoperative ultrasonography and cholangioscopy of common bile duct and Virsung were performed as a routine. The procedures depended on the localization and the grade of advance of the tumors. UICC classification of pancreatic tumors, pTNM (4th edition 1987) it was used. Only in 25 patients (8%) (tumors pT1a-bN0M0) it was possible to perform radical operation (resection of the pancreas). However in 172 patients (56%) only palliative procedures were done (pT2N1M0). In 95 patients (31%) only laparotomy and biopsy were performed (tumors pT2N1M1). The study shows that although diagnostic methods are improved, the tumors of the pancreas are diagnosed in stages making unable the radical procedures. Only about 10% of carcinomas are resectable. It is caused by with non-characteristic picture of the disease in its early stage.
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Affiliation(s)
- H Razak
- Kliniki Chirurgii Ogólnej Akademii Medycznej w Białymstoku
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41
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Polakow J, Ladny JR, Dzieciol J, Puchalski Z. Ultrasound guided percutaneous fine-needle biopsy of the liver: efficacy of color doppler sonography. Hepatogastroenterology 1998; 45:1829-30. [PMID: 9840156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND/AIMS Fine-needle biopsy (FNB) is one of the diagnostic methods for the diagnosis of focal lesions in the liver. The method is relatively fast, inexpensive and safe. Complications after FNB are observed in only a few cases. Color Doppler sonography (CDS) is one way of minimizing the number of FNB complications. The aim of the present study is to evaluate CDS in the monitoring of FNB in the diagnosis of focal lesions in the liver. METHODOLOGY The patient group consisted of 73 patients: 28 male and 45 female with a mean age of 53.5 years. Initially, all patients were examined using traditional B-mode gray-scale sonography. After visualization of focal lesions in the liver their echostructure and position were analyzed. Color Doppler sonography was the introduced for the visualization of vascularization of the liver. FNB was performed under the guidance of CDS. The cytological specimens obtained were microscopically evaluated. RESULTS Of the 73 patients, 18 cases were diagnosed with liver abscess, 19 with cysts of the liver, and 36 with malignant tumors. Amongst the patients with malignancy tumors, the tumors were unifocal in 15 cases, and multifocal in 221. Histopathologically, there were primary hepatocellular carcinomas in 22 patients and metastatic tumors in 14 patients. During the first 48 hours after FNB no complications such as subcapsular hematoma or intraperitoneal bleeding were observed. CONCLUSIONS Introducing CDS for ultrasound guided percutaneous FNB of the liver avoids such complications as bleeding, especially in patients with a high risk of hemorrhage.
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Affiliation(s)
- J Polakow
- Department of Radiology, Medical University of Bialystok, Poland
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42
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Pruszyński K, Ladny JR, Puchalski Z. [Use of Tienam in treatment of severe acute pancreatitis]. Przegl Lek 1998; 55:133-5. [PMID: 9695657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Therapeutic results obtained in the management of severe acute pancreatitis (AP) complications are still unsatisfactory, and mortality rate is about 40%. An improvement in treatment effectiveness can be related to successful control of infections and prevention of uncontrollable sepsis. The aim of the study was evaluation of effectiveness of Tienam in the management of severe acute pancreatitis complications. The clinical material included 24 patients, treated for AP between 1994 and 1996. All of the patients were operated on and 19 of them required at least one reoperation. During primary surgery we performed necrosectomy and continuous peritoneal lavage. The analysis of cultures obtained from infected necrotic tissue, pancreatic abscesses and whole blood showed that the infections were caused mainly by Gram-negative bacteria. The highest efficiency in infections control was observed in the case of Tienam (15% resistant strains). The authors emphasize also the increasing role of Staphylococcus aureus and Candida albicans in secondary infections.
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Affiliation(s)
- K Pruszyński
- Kliniki Chirurgii Ogólnej, Akademii Medycznej w Białymstoku
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43
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Dadan J, Ladny JR, Puchalski Z. Hyperthyroid goitre treated surgically. Rocz Akad Med Bialymst 1998; 42:81-8. [PMID: 9581467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the study was the comparative analysis of the degree of intensity of male and female hyperthyroidism treated surgically in the years 1990 to 1996. In this period 295 females and 42 males underwent operation for hyperthyroid goitre. Female predominance was noted in hyperthyroidism (ratio 7:1), in Graves' disease (7.4:1) and in toxic nodular goitre (6.3:1). The clinical findings in pre- and postoperative patients, including laboratory, visual diagnosis, and intra- and postoperative complications were evaluated. In the preoperative period, the incidence of the thyreocardiac syndrome was greater in the male. Male hyperthyroidic goitres were more frequently located retrosternally and caused trachea compression. No significant sexual differences were found in routine laboratory tests. Operations for hyperthyroidic male goitres usually caused more intraoperative problems and were connected with greater blood loss. Estimation of cardio-vascular parameters in the early postoperative period showed higher intensification of hyperkinetic circulation and higher mean body temperature in men. Signs of psychosis developed postoperatively in two men. The analysis of patients with hyperthyroidic goitre treated surgically revealed more severe course of male thyreotoxicosis in the perioperative period.
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Affiliation(s)
- J Dadan
- Department of General Surgery Medical Academy of Białystok
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Polaków J, Ladny JR, Dziecioł J, Puchalski Z, Walecki J. Colour doppler sonography guided percutaneous fine-needle biopsy of the liver. Rocz Akad Med Bialymst 1998; 42:241-4. [PMID: 9581487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Between 1992 and 1997, every year, approximately 30,000 examinations of the liver and bile ducts were done. Addition of colour Doppler imaging improves safety of procedures and allowed to perform ultrasound guided biopsy in 73 patients. On the basis of our experience we state that colour Doppler sonography guided percutaneous fine needle biopsy of the liver is useful, sufficient and safety diagnostic method of abscesses, cysts and malignant tumours of the liver.
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Affiliation(s)
- J Polaków
- Department of Radiology, Medical Academy of Białystok, Poland
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45
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Dzienis H, Pruszyński K, Ladny JR, Puchalski Z, Dadan J. [Polymorphism of collagen in duodenal mucosa of ulcers]. Wiad Lek 1998; 50 Suppl 1 Pt 2:354-7. [PMID: 9424903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Determinations of collagen in specimens of duodenal mucosa taken from 15 patients operated on because of duodenal ulcer with pyloric stenosis were performed. In the ulcer and surrounding tissue, total collagen values were significantly increased when compared with the results in unchanged wall of the duodenum. Collagen polymorphism study showed considerably higher percentage of type I and decreased type III in the ulceration than in control duodenal mucosa. In conclusion, extracellular components of connective tissue may play a role in the formation and course of duodenal ulcer disease.
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Affiliation(s)
- H Dzienis
- Kliniki Chirurgii Ogólnej Akademii Medycznej w Białymstoku
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46
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Ladny JR, Dzienis H, Dadan J, Polaków J, Venskutonis D, Puchalski Z. [The effect of some drugs on the levels of selected cytokines in experimental septic shock]. Wiad Lek 1998; 50 Suppl 1 Pt 2:247-51. [PMID: 9424882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The production of tumor necrosis factor (TNF-alpha), and interleukin 1 beta (IL-1 beta), IL-6, sTNFR-p55, sTNFR-p75 and their pharmacomodulation were evaluated in a model of septic shock induced in CD-1 mice by cecal ligation and puncture (CLP). This model of sepsis, which resembles the clinical situation of bowel perforation and peritonitis with subsequent septic shock was compared with that induced by administration of pure endotoxin (LPS). TNF-alpha was detectable in serum, liver, spleen and lungs during the first 4 h, with a peak 2 h after CLP. IL-1 beta was measurable in serum after 24 h, and levels increased significantly in spleen and liver 4 and 8 h after CLP. IL-6 levels increased significantly in serum throughout the first 16 h after CLP. sTNFR-p55 and p75 increased in both models of shock but with different kinetics. Cytokines were also detectable after LPS injection, with kinetics similar to those after CLP but a significantly higher level. Pretreatment with dexamethasone (DEX) and ibuprofen (IBU), significantly reduced survival, while TNF did not affect it. Only pentoxifylline (PTX) significantly increased survival in mice with CLP. However DEX protected the mice from LPS mortality. In conclusion, by inhibiting TNF-alpha with DEX and PTX survival was reduced or unchanged respectively, suggesting that the modulation of this cytokine does not play significant role in sepsis and septic shock induced by CLP, unlike treatment with LPS. The negative effects of IBU suggests a protective role by prostaglandins in sepsis induced by LPS.
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Affiliation(s)
- J R Ladny
- Kliniki Chirurgii Ogólnej, Akademii Medycznej w Białymstoku
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Polaków J, Ladny JR, Krejza J, Szulc S. Ultrasound vascular imaging with subtraction in evaluation of lung tumor vascularity--a case report. Rocz Akad Med Bialymst 1997; 42 Suppl 1:280-6. [PMID: 9337545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ultrasound vascular imaging with subtraction is considered as very useful method to evaluation vascularity of tumor and its relationships to great vessels. Lung tumor was evaluated with power color Doppler ultrasound with and without B-mode scanning. Power color Doppler imaging without B-mode scanning is better depicted tumor internal vascular architecture and its relationships to great vessels then with B-mode. This method makes differentiation of tumor character possibly and interventional procedures more safely.
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Affiliation(s)
- J Polaków
- Department of Radiology, Medical Academy of Białystok
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Polaków J, Ladny JR, Dziecioł J, Szulc S, Krejza J. Evaluation of colour Doppler sonography in lung tumor biopsy. Rocz Akad Med Bialymst 1997; 42 Suppl 1:314-7. [PMID: 9337549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 1986 and 1995, 1800 ultrasound examinations of the chest were done. Addition of colour Doppler imaging improves safety of procedures and allowed to perform ultrasound guided biopsy in 47 patients. On the basis of our experience we state that colour Doppler sonography guided needle aspiration biopsy is useful, sufficient and safety diagnostic method of malignant lung masses, especially peripheral and wall-chest located.
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Affiliation(s)
- J Polaków
- Department of Radiology, Medical Academy of Białystok
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49
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Kuźmiuk J, Wasielica M, Ladny JR. [Giant nodular goiter]. Pol Merkur Lekarski 1997; 3:83-5. [PMID: 9480184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The paper presents own experience in surgical treatment of nodular goitre with mass exceeding 1000 g. In the analysed material of 1180 strumectomies, three such cases were found. Preparation for surgery included administration of Lugol solution, and possibly anxiolytics. The operation of removal of giant nodular goitre caused no significant technical difficulties. The postoperative course was uncomplicated, and cosmetic effect in remote examination was satisfactory.
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Affiliation(s)
- J Kuźmiuk
- Oddziału Chirurgii Ogólnej Wojewódzkiego, Szpitala Zespolonego im. Sniadeckiego, Białymstoku
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Polaków J, Ladny JR, Krejza J. Focal solitary hypoechoic area in hepatic fatty infiltration: a cause of hepatic pseudomass in ultrasound examination. Rocz Akad Med Bialymst 1996; 41:499-504. [PMID: 9020564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A unusual pattern of hepatic fatty infiltration was detected sonographically in 43 patients over a 2-year period. At appropriate gain settings and time gain compensations, the liver parenchyma demonstrated diffuse increased echogenicity except for a solitary hypoechoic area with relatively distinct margins, usually locate in the medial segment of the left hepatic lobe or right lobe in pericholecystic, perivascular or subcapsular locations. This hypoechoic focus varied in size between 15 and 50 mm and was typically ovoid, but was occasionally spherical or irregular in shape. Fourteen patients with such skip area underwent percutaneous needle biopsy because of concern that there was a space-occupying mass. Microscopic examination of specimens from the hypoechoic region revealed normal hepatic parenchymal cells, while tissue samples from the surrounding liver had high fat levels. In the remaining 29 patients, correlative radiologic studies supported the diagnosis of fatty liver and excluded a central-mass lesion. A localized area of normal hepatic tissue should be considered among the possible hypoechoic periportal area demonstrated within a fatty liver.
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Affiliation(s)
- J Polaków
- Department of Radiology, Medical Academy of Białystok
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