1
|
Grüßer L, Bayram B, Ziemann S, Wallqvist J, Wienhold J, Rossaint R, Derwall M, Follmann A. Teleconsultation for Preoperative Anesthesia Evaluation: Identifying Environmental Potentials by Life Cycle Assessment. Telemed J E Health 2024. [PMID: 38656124 DOI: 10.1089/tmj.2023.0700] [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] [Indexed: 04/26/2024] Open
Abstract
Introduction: Teleconsultations for preoperative evaluation in anesthesiology proved to be feasible during the COVID-19 pandemic. However, widespread implementation of teleconsultations has not yet occurred. Besides time savings and economic benefits, teleconsultations in anesthesia may have the potential to reduce CO2 emissions. Methods: We conducted a life cycle assessment based on prospective surveys to assess the potential environmental benefits of preoperative anesthesia teleconsultations in comparison to the status-quo in-person consultations. Within 1 month, all patients presenting at the preoperative anesthesia clinic at RWTH Aachen University Hospital were asked about the distance traveled and mode of transportation to the hospital. The main outcome measure was the potential environmental benefit resulting from the implementation of teleconsultations. Results: In total, 821 out of 981 patients presenting at the anesthesia clinic participated in the survey. Most patients visited on an outpatient basis (62.9%) and traveled by car (81.7%). The median travel distance was 25 km [interquartile range 12-40]. If patients who came to the hospital solely for the anesthesia appointment had scheduled virtual appointments, the emissions of 3.03-ton CO2 equivalents (CO2-eq) could be avoided in the first month after implementation. The environmental impact associated with the production of teleconsultation equipment is outweighed by the reduction in patient travel. If all outpatient appointments were performed virtually, these savings would triple. Within 10 years, more than 1,300 tons CO2-eq could be avoided. Conclusion: Teleconsultations can mitigate the environmental impact of in-person anesthesia consultations. Further research is essential to leverage teleconsultations for preoperative evaluation also across other medical specialties.
Collapse
Affiliation(s)
- Linda Grüßer
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Berfin Bayram
- Department Anthropogenic Material Cycles, RWTH Aachen University, Aachen, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Wallqvist
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Wienhold
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesia, Critical Care and Pain Medicine, St. Johannes Hospital Dortmund, Dortmund, Germany
| | - Andreas Follmann
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
2
|
Röhrig EJ, Schenkat H, Hochhausen N, Röhl AB, Derwall M, Rossaint R, Kork F. Comparing Charlson Comorbidity Index Scores between Anesthesiologists, Patients, and Administrative Data: A Prospective Observational Study. J Clin Med 2024; 13:1469. [PMID: 38592678 PMCID: PMC10932213 DOI: 10.3390/jcm13051469] [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: 01/27/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Patients' comorbidities play an immanent role in perioperative risk assessment. It is unknown how Charlson Comorbidity Indices (CCIs) from different sources compare. (2) Methods: In this prospective observational study, we compared the CCIs of patients derived from patients' self-reports and from physicians' assessments with hospital administrative data. (3) Results: The data of 1007 patients was analyzed. Agreement between the CCI from patients' self-report compared to administrative data was fair (kappa 0.24 [95%CI 0.2-0.28]). Agreement between physicians' assessment and the administrative data was also fair (kappa 0.28 [95%CI 0.25-0.31]). Physicians' assessment and patients' self-report had the best agreement (kappa 0.33 [95%CI 0.30-0.37]). The CCI calculated from the administrative data showed the best predictability for in-hospital mortality (AUROC 0.86 [95%CI 0.68-0.91]), followed by equally good prediction from physicians' assessment (AUROC 0.80 [95%CI 0.65-0.94]) and patients' self-report (AUROC 0.80 [95%CI 0.75-0.97]). (4) Conclusions: CCIs derived from patients' self-report, physicians' assessments, and administrative data perform equally well in predicting postoperative in-hospital mortality.
Collapse
Affiliation(s)
- Eike J. Röhrig
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Henning Schenkat
- Deanery of Studies, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Nadine Hochhausen
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Anna B. Röhl
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Matthias Derwall
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| | - Felix Kork
- Department of Anesthesiology, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany; (E.J.R.); (N.H.); (A.B.R.); (M.D.); (R.R.)
| |
Collapse
|
3
|
Follmann A, Wienhold J, Arnolds A, Derwall M, Rossaint R, Czaplik M. [Telemedical anesthesia consent - Are the patients ready for it? : A comparative requirement analysis before and during the pandemic]. Anaesthesiologie 2024; 73:156-164. [PMID: 38366156 PMCID: PMC10920479 DOI: 10.1007/s00101-024-01387-4] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Comprehensive anesthesia preparation by means of the anamnesis and physical examination is considered an essential part of the quality criteria for anesthesia. Especially due to the shortage of specialists, there are usually long waiting times in anesthesia outpatient departments and patients must frequently return in cases of missing or pending findings. Telemedicine already offers alternatives in the context of video communication. These alternatives are now particularly prominent due to the currently existing COVID-19 pandemic and the resulting recommendations for digitalization. OBJECTIVES This comparative cross-sectional study was carried out to show via a patient survey which patient groups are suitable for a telemedical anesthesia preparation and whether the patients are already technically sufficiently equipped. MATERIAL AND METHODS For this purpose, a total of 2080 patients (1030 before and 1050 during the pandemic) were interviewed using a questionnaire. For matched paired analyses, 630 pairs were formed according to their age and gender. RESULTS Before and after the pandemic, there was an increase in the percentage of patients already using video communication in their daily lives (30.4% vs. 41.8%). Before the pandemic, 31.7% of patients indicated that they considered this concept of communication to be a practical and appropriate method for an educational conversation and after the pandemic this number increased to 46.6%. For the majority of patients personal contact with a local anesthesiologist was important (80.7% before vs. 67.4% during the pandemic). The number of patients who had the necessary technical equipment for video communication also increased as a result of the COVID-19 pandemic (50.4% vs. 58.2%). DISCUSSION Almost half of the patients already seem to be open to a telemedical preoperative evaluation. As digitalization progresses, older generations are more likely to recognize the benefits and be able to own and use the necessary technology in the near future. User acceptance should be the central goal of concept development. This must be followed by a randomized controlled study to evaluate the potentials but also the problems in the perioperative process.
Collapse
Affiliation(s)
- A Follmann
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - J Wienhold
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - A Arnolds
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Derwall
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, St. Johannes Hospital Dortmund, Dortmund, Deutschland
| | - R Rossaint
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Docs in Clouds TeleCare GmbH, Aachen, Deutschland
| | - M Czaplik
- Uniklinik RWTH Aachen, Klinik für Anästhesiologie, Pauwelsstr. 30, 52074, Aachen, Deutschland
- Docs in Clouds TeleCare GmbH, Aachen, Deutschland
| |
Collapse
|
4
|
Wienhold J, Kemper I, Czaplik M, Follmann A, Rossaint R, Derwall M. [Teleconsultation for preoperative evaluation and informed consent-Are we ready for a paradigm shift?]. Anaesthesiologie 2023; 72:697-702. [PMID: 37563314 DOI: 10.1007/s00101-023-01319-8] [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] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
In Germany, approximately 17 million anaesthesiological procedures and, consequently, roughly the same number of preoperative consultations are conducted each year. So far, these have predominantly taken place in person. However, recent developments in technology, medical-legal aspects, and politics, combined with the catalyzing effect of the pandemic situation, have led to a significant boost in telemedicine. In the field of anaesthesia, there are new approaches to implementing telemedicine in the pre- and postoperative setting. This article focuses on the preoperative setting and presents general requirements for a teleconsultation as preoperative evaluation, the current state of technology, and medical-legal aspects.
Collapse
Affiliation(s)
- Jan Wienhold
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Ilka Kemper
- Geschäftsbereich Recht, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Michael Czaplik
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Andreas Follmann
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Rolf Rossaint
- Klinik für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Matthias Derwall
- St. Johannes Hospital Dortmund, Johannesstraße 9-17, 44137, Dortmund, Deutschland
| |
Collapse
|
5
|
Wienhold J, Mösch L, Rossaint R, Kemper I, Derwall M, Czaplik M, Follmann A. Teleconsultation for preoperative evaluation during the coronavirus disease 2019 pandemic: A technical and medical feasibility study. Eur J Anaesthesiol 2021; 38:1284-1292. [PMID: 34669644 PMCID: PMC8630926 DOI: 10.1097/eja.0000000000001616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the surge in coronavirus disease 2019 (COVID-19) infections in early 2020, many medical organisations began developing strategies for implementing teleconsultation to maintain medical services during lockdown and to limit physical contact. Therefore, we developed a teleconsultation preoperative evaluation platform to replace on-site preoperative meetings. OBJECTIVE This study assessed the feasibility of a teleconsultation for preoperative evaluation and procedure-associated adverse events. DESIGN Implementation study. SETTING A tertiary care university hospital in Germany from April 2020 to October 2020. PATIENTS One hundred and eleven patients scheduled for elective surgery. INTERVENTION Patients were assigned to receive teleconsultation for preoperative evaluation and to complete a subsequent survey. MAIN OUTCOME MEASURES Primary endpoints were medical and technical feasibility, user satisfaction and time savings. RESULTS For 100 out of 111 patients, telepreoperative consultations allowed for adequate perioperative risk assessment, patient education and also for effective collection of legal signatures. For six patients (5.4%), consultations could not be started because of technical issues, whereas for five patients (4.8%), clearance for surgery could not be granted because of medical reasons. A clear majority of anaesthetists (93.7%) rated the telepreoperative evaluations as equivalent to on-site meetings. The majority of the patients considered teleconsultation for preoperative evaluation as convenient as an on-site meeting (98.2%) and would choose a teleconsultation again (97.9%). Median travel time saved by patients was 60 min (Q1 40, Q3 80). We registered one adverse event: we detected atrial fibrillation in one patient only immediately prior to surgery. CONCLUSION Telepreoperative evaluations are medically and technically feasible, yielding high satisfaction rates on both sides. However, regarding patient safety, not every patient is equally well suited. Overall, implementation of teleconsultation for preoperative evaluation into clinical routine could help maintain medical care during the COVID-19 pandemic. TRIAL REGISTRATION NCT04518514, ClinicalTrials.gov.
Collapse
Affiliation(s)
- Jan Wienhold
- From the Department of Anaesthesiology (JW, LM, RR, MD, MC, AF) and Legal Affairs Division, University Hospital RWTH Aachen, Aachen, Germany (IK)
| | | | | | | | | | | | | |
Collapse
|
6
|
Derwall M, Grottke O. Coagulation management for a caesarean delivery in a mother with severe homozygous Factor V deficiency. J Clin Anesth 2021; 74:110402. [PMID: 34157596 DOI: 10.1016/j.jclinane.2021.110402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/02/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Matthias Derwall
- From the Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Oliver Grottke
- From the Department of Anaesthesiology, University Hospital RWTH Aachen, Medical Faculty, RWTH Aachen University, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
| |
Collapse
|
7
|
Nix C, Zayat R, Ebeling A, Goetzenich A, Chandrasekaran U, Rossaint R, Hatam N, Derwall M. Inhaled nitric oxide preserves ventricular function during resuscitation using a percutaneous mechanical circulatory support device in a porcine cardiac arrest model: an echocardiographic myocardial work analysis. BMC Cardiovasc Disord 2021; 21:189. [PMID: 33865330 PMCID: PMC8052698 DOI: 10.1186/s12872-021-01992-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/07/2021] [Indexed: 02/01/2023] Open
Abstract
Background Resuscitation using a percutaneous mechanical circulatory support device (iCPR) improves survival after cardiac arrest (CA). We hypothesized that the addition of inhaled nitric oxide (iNO) during iCPR might prove synergistic, leading to improved myocardial performance due to lowering of right ventricular (RV) afterload, left ventricular (LV) preload, and myocardial energetics. This study aimed to characterize the changes in LV and RV function and global myocardial work indices (GWI) following iCPR, both with and without iNO, using 2-D transesophageal echocardiography (TEE) and GWI evaluation as a novel non-invasive measurement. Methods In 10 pigs, iCPR was initiated following electrically-induced CA and 10 min of untreated ventricular fibrillation (VF). Pigs were randomized to either 20 ppm (20 ppm, n = 5) or 0 ppm (0 ppm, n = 5) of iNO in addition to therapeutic hypothermia for 5 h following ROSC. All animals received TEE at five pre-specified time-points and invasive hemodynamic monitoring. Results LV end-diastolic volume (LVEDV) increased significantly in both groups following CA. iCPR alone led to significant LV unloading at 5 h post-ROSC with LVEDV values reaching baseline values in both groups (20 ppm: 68.2 ± 2.7 vs. 70.8 ± 6.1 mL, p = 0.486; 0 ppm: 70.8 ± 1.3 vs. 72.3 ± 4.2 mL, p = 0.813, respectively). LV global longitudinal strain (GLS) increased in both groups following CA. LV-GLS recovered significantly better in the 20 ppm group at 5 h post-ROSC (20 ppm: − 18 ± 3% vs. 0 ppm: − 13 ± 2%, p = 0.025). LV-GWI decreased in both groups after CA with no difference between the groups. Within 0 ppm group, LV-GWI decreased significantly at 5 h post-ROSC compared to baseline (1,125 ± 214 vs. 1,835 ± 305 mmHg%, p = 0.011). RV-GWI was higher in the 20 ppm group at 3 h and 5 h post-ROSC (20 ppm: 189 ± 43 vs. 0 ppm: 108 ± 22 mmHg%, p = 0.049 and 20 ppm: 261 ± 54 vs. 0 ppm: 152 ± 42 mmHg%, p = 0.041). The blood flow calculated by the Impella controller following iCPR initiation correlated well with the pulsed-wave Doppler (PWD) derived pulmonary flow (PWD vs. controller: 1.8 ± 0.2 vs. 1.9 ± 0.2L/min, r = 0.85, p = 0.012). Conclusions iCPR after CA provided sufficient unloading and preservation of the LV systolic function by improving LV-GWI recovery. The addition of iNO to iCPR enabled better preservation of the RV-function as determined by better RV-GWI. Additionally, Impella-derived flow provided an accurate measure of total flow during iCPR. ![]()
Collapse
Affiliation(s)
- Christoph Nix
- Department of Anesthesiology, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany.,Abiomed Europe GmbH, Aachen, Germany
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany.
| | - Andreas Ebeling
- Department of Anesthesiology, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| | - Andreas Goetzenich
- Department of Anesthesiology, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany.,Abiomed Europe GmbH, Aachen, Germany
| | | | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| | - Nima Hatam
- Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| | - Matthias Derwall
- Department of Anesthesiology, Medical Faculty, RWTH University Hospital Aachen, RWTH Aachen University, 52074, Aachen, Germany
| |
Collapse
|
8
|
Billig S, Zayat R, Ebeling A, Steffen H, Nix C, Hatam N, Schnöring H, Derwall M. Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work. Int J Cardiovasc Imaging 2021; 37:835-846. [PMID: 33048268 PMCID: PMC7969559 DOI: 10.1007/s10554-020-02053-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281-2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72-88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.
Collapse
Affiliation(s)
- Sebastian Billig
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Rashad Zayat
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Andreas Ebeling
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Henning Steffen
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Christoph Nix
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, 52074, Germany
| | - Nima Hatam
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Heike Schnöring
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Matthias Derwall
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany.
| |
Collapse
|
9
|
Derwall M, Coburn M. Safety and quality of perioperative anesthesia care-Ensuring safe care for older people living with frailty. Best Pract Res Clin Anaesthesiol 2020; 35:3-9. [PMID: 33742576 DOI: 10.1016/j.bpa.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/29/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
The clinical concept of frailty as a detectable and improvable clinical condition has emerged in the field of geriatric medicine over the past two decades. Albeit frailty can be described as the rapid deterioration of organ function during the physiological aging process, this syndrome is not exclusively limited to the elderly. Recently, this concept has been introduced in the field of anesthesia and critical care as a means to better appraise perioperative risks and offer patient-centered individual treatment pathways. Extensive efforts have been invested into the research on tools for the detection and quantification of frailty. However, while multiple tools have been validated for the detection of frailty in different populations, no universal score or test has been validated to be universally applicable. Furthermore, it is unclear whether interventions capable of improving the detected degree of frailty may result in better outcomes. Ongoing and future research is aimed at developing automated systems that help in harnessing standard medical records for reliable frailty screening without additional user input. Further efforts are pointed at understanding the potential reversibility of frailty through interventions such as exercise or nutritional supplements. While the role of frailty detection, quantification, and treatment in anesthesia and critical care is limited today, it is likely that it may become a key element of perioperative care of older patients in the near future.
Collapse
Affiliation(s)
- Matthias Derwall
- Department of Anesthesiology, University Hospital RWTH Aachen, Medical Faculty RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Mark Coburn
- Department of Anesthesiology, University Hospital RWTH Aachen, Medical Faculty RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| |
Collapse
|
10
|
|
11
|
Abstract
BACKGROUND After exhaustion of all conservative measures in the treatment of acute and chronic heart insufficiency, there is the possibility to temporarily or permanently support or replace the pump performance of the heart by mechanical circulatory support (MCS) systems. OBJECTIVE Presentation of the most important cardiac support systems for intensive care medicine, their indications and important risk factors. MATERIAL AND METHODS Critical review of device manufacturer's specifications, current research and expert opinions. RESULTS The spectrum of available MCS procedures include mechanical chest compression devices, catheter-based micropumps and complete artificial hearts. Device selection depends on the severity of heart failure (monoventricular or biventricular pump failure), the expected duration of treatment and the degree of lung function impairment. The decision between minimally invasive and open surgical procedures depends on the options established at the specific healthcare institution and whether the heart function is to be temporarily or permanently replaced. Compliance with the anticoagulation regimens defined by the manufacturer is especially important as they differ vastly between devices and are critical to avoid bleeding or thromboembolic complications. CONCLUSION Due to the increasing number of patients on long-term mechanical circulatory support, the chances are that physicians in the initial emergency admission are unfamiliar with these devices but need to operate them in emergency cases. Therefore, knowledge of these procedures and their complications becomes increasingly important.
Collapse
Affiliation(s)
- M Derwall
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - A Moza
- Klinik für Thorax‑, Herz- und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - A Brücken
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| |
Collapse
|
12
|
Martin L, Derwall M, Al Zoubi S, Zechendorf E, Reuter DA, Thiemermann C, Schuerholz T. Response. Chest 2019; 155:647-648. [PMID: 30846068 DOI: 10.1016/j.chest.2018.10.018] [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: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lukas Martin
- Department of Intensive Care and Intermediate Care, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen; William Harvey Research Institute, Queen Mary University of London.
| | - Matthias Derwall
- Department of Intensive Care and Intermediate Care, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen
| | - Sura Al Zoubi
- William Harvey Research Institute, Queen Mary University of London
| | - Elisabeth Zechendorf
- Department of Intensive Care and Intermediate Care, University Hospital, Rheinisch-Westfälische Technische Hochschule Aachen
| | - Daniel A Reuter
- Department of Anesthesia and Intensive Care, University Hospital Rostock
| | | | - Tobias Schuerholz
- Department of Anesthesia and Intensive Care, University Hospital Rostock
| |
Collapse
|
13
|
Derwall M, Martin L, Rossaint R. The acute respiratory distress syndrome: pathophysiology, current clinical practice, and emerging therapies. Expert Rev Respir Med 2018; 12:1021-1029. [PMID: 30431366 DOI: 10.1080/17476348.2018.1548280] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION More than fifty years after the first description of acute respiratory distress syndrome (ARDS) by Ashbaugh and colleagues, no specific treatment of the underlying pathophysiological processes is available. The current therapeutic regime is comprised of supportive measures such as lung protective ventilation, restrictive fluid management, paralyzing drugs, and prone positioning. Although vast improvements have been made in ARDS-treatment during the last five decades, mortality among patients with severe ARDS remains at an unacceptable rate of 45%. Areas covered: This article reviews the evolution of the currently used definition, established pathophysiological mechanism, highlights the current best clinical practice to treat ARDS, gives a brief outlook on cutting edge trends in ARDS research and closes with an expert opinion on the subject. Expert commentary: Individualizing the provided measures to specific genotypes is the key challenge in ARDS research today. The ongoing digital revolution will help to individualize ARDS-treatment and will therefore presumably improve survival and quality of life.
Collapse
Affiliation(s)
- Matthias Derwall
- a Klinik für Anästhesiologie , Uniklinik RWTH Aachen, Medizinische Fakultät RWTH Aachen , Aachen , Germany.,b Klinik für Operative Intensivmedizin und Intermediate Care , Uniklinik RWTH Aachen, Medizinische Fakultät RWTH Aachen , Aachen , Germany
| | - Lukas Martin
- a Klinik für Anästhesiologie , Uniklinik RWTH Aachen, Medizinische Fakultät RWTH Aachen , Aachen , Germany.,b Klinik für Operative Intensivmedizin und Intermediate Care , Uniklinik RWTH Aachen, Medizinische Fakultät RWTH Aachen , Aachen , Germany
| | - Rolf Rossaint
- a Klinik für Anästhesiologie , Uniklinik RWTH Aachen, Medizinische Fakultät RWTH Aachen , Aachen , Germany.,b Klinik für Operative Intensivmedizin und Intermediate Care , Uniklinik RWTH Aachen, Medizinische Fakultät RWTH Aachen , Aachen , Germany
| |
Collapse
|
14
|
Martin L, Derwall M, Al Zoubi S, Zechendorf E, Reuter DA, Thiemermann C, Schuerholz T. The Septic Heart: Current Understanding of Molecular Mechanisms and Clinical Implications. Chest 2018; 155:427-437. [PMID: 30171861 DOI: 10.1016/j.chest.2018.08.1037] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [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: 02/07/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/25/2023] Open
Abstract
Septic cardiomyopathy is a key feature of sepsis-associated cardiovascular failure. Despite the lack of consistent diagnostic criteria, patients typically exhibit ventricular dilatation, reduced ventricular contractility, and/or both right and left ventricular dysfunction with a reduced response to volume infusion. Although there is solid evidence that the presence of septic cardiomyopathy is a relevant contributor to organ dysfunction and an important factor in the already complicated therapeutic management of patients with sepsis, there are still several questions to be asked: Which factors/mechanisms cause a cardiac dysfunction associated with sepsis? How do we diagnose septic cardiomyopathy? How do we treat septic cardiomyopathy? How does septic cardiomyopathy influence the long-term outcome of the patient? Each of these questions is interrelated, and the answers require a profound understanding of the underlying pathophysiology that involves a complex mix of systemic factors and molecular, metabolic, and structural changes of the cardiomyocyte. The afterload-related cardiac performance, together with speckle-tracking echocardiography, could provide methods to improve the diagnostic accuracy and guide therapeutic strategies in patients with septic cardiomyopathy. Because there are no specific/causal therapeutics for the treatment of septic cardiomyopathy, the current guidelines for the treatment of septic shock represent the cornerstone of septic cardiomyopathy therapy. This review provides an up-to-date overview of the current understanding of the pathophysiology, summarizes the evidence of currently available diagnostic tools and treatment options, and highlights the importance of further urgently needed studies aimed at improving diagnosis and investigating novel therapeutic targets for septic cardiomyopathy.
Collapse
Affiliation(s)
- Lukas Martin
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany; William Harvey Research Institute, Queen Mary University London, London, United Kingdom.
| | - Matthias Derwall
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Sura Al Zoubi
- William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Elisabeth Zechendorf
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniel A Reuter
- Department of Anesthesia and Intensive Care, University Hospital Rostock, Rostock, Germany
| | - Chris Thiemermann
- William Harvey Research Institute, Queen Mary University London, London, United Kingdom
| | - Tobias Schuerholz
- Department of Anesthesia and Intensive Care, University Hospital Rostock, Rostock, Germany
| |
Collapse
|
15
|
Derwall M, Rossaint R. ECMO in severe acute respiratory distress syndrome: a light at the end of the tunnel? Lancet Respir Med 2018; 6:661-662. [PMID: 30037713 DOI: 10.1016/s2213-2600(18)30278-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Matthias Derwall
- Department of Anaesthesiology, University Hospital Aachen, Medical Faculty, RWTH Aachen University, D-52074 Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, Medical Faculty, RWTH Aachen University, D-52074 Aachen, Germany.
| |
Collapse
|
16
|
Brücken A, Bleilevens C, Berger P, Nolte K, Gaisa NT, Rossaint R, Marx G, Derwall M, Fries M. Effects of inhaled nitric oxide on outcome after prolonged cardiac arrest in mild therapeutic hypothermia treated rats. Sci Rep 2018; 8:6743. [PMID: 29713000 PMCID: PMC5928159 DOI: 10.1038/s41598-018-25213-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/10/2018] [Indexed: 12/28/2022] Open
Abstract
Guidelines endorse targeted temperature management to reduce neurological sequelae and mortality after cardiac arrest (CA). Additional therapeutic approaches are lacking. Inhaled nitric oxide (iNO) given post systemic ischemia/reperfusion injury improves outcomes. Attenuated inflammation by iNO might be crucial in brain protection. iNO augmented mild therapeutic hypothermia (MTH) may improve outcome after CA exceeding the effect of MTH alone. Following ten minutes of CA and three minutes of cardiopulmonary resuscitation, 20 male Sprague-Dawley rats were randomized to receive MTH at 33 °C for 6hrs or MTH + 20ppm iNO for 5hrs; one group served as normothermic control. During the experiment blood was taken for biochemical evaluation. A neurological deficit score was calculated daily for seven days post CA. On day seven, brains and hearts were harvested for histological evaluation. Treatment groups showed a significant decrease in lactate levels six hours post resuscitation in comparison to controls. TNF-α release was significantly lower in MTH + iNO treated animals only at four hours post ROSC. While only the combination of MTH and iNO improved neurological function in a statistically significant manner in comparison to controls on days 4–7 after CA, there was no significant difference between groups treated with MTH and MTH + iNO.
Collapse
Affiliation(s)
- Anne Brücken
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Christian Bleilevens
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Philipp Berger
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Kay Nolte
- Institute of Neuropathology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Nadine T Gaisa
- Institute of Pathology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Rolf Rossaint
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Matthias Derwall
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Michael Fries
- Department of Anaesthesiology, St. Vincenz Hospital Limburg, Auf dem Schafsberg, 65549, Limburg, Germany
| |
Collapse
|
17
|
De Chiara B, Ranjbar S, Szczesniak-Stanczyk D, Gabrielli L, Djikic D, Barbier P, Hristova K, Erne D, Zayat R, Crowe TM, Almeida J, Marketou M, Caspar T, Kouris N, Pontone G, Trifunovic D, Cusma Piccione M, Madeira M, Lovric D, Drakopoulou M, Fries B, Krivickiene A, Mateescu AD, Stella S, Casadei F, Peritore A, Spano F, Santambrogio G, Vicario M, Trolese I, Gallina C, Giannattasio C, Moreo A, Karvandi M, Badano LP, Brzozowski W, Blaszczyk R, Szyszko M, Zarczuk R, Janowski M, Wysokinski A, Stanczyk B, Sitges M, Castro P, Verdejo H, Ocaranza MP, Sepulveda P, Llevaneras S, Baraona F, Salinas M, Lavanderos S, Mujovic N, Dejanovic B, Peric V, Marinkovic M, Jankovic N, Orbovic B, Simic D, Guglielmo M, Salvini L, Savioli G, Dasheva A, Marinov R, Lasarov S, Mitev I, M P, Rhodes K, Bartlett M, Chong A, Wahi S, Derwall M, Ebeling A, Nix C, Marx G, Autschbach R, Hatam N, Sonecki P, Brewis MJ, Church AC, Johnson MK, Peacock AJ, Fontes-Carvalho R, Sampaio F, Ribeiro J, Bettencourt P, Leite-Moreira A, Azevedo A, Kontaraki J, Parthenakis P, Maragkoudakis S, Touloupaki M, Patrianakos A, Konstantinou J, Vernardos M, Logakis J, Vardas P, El Ghannudi S, Ohlmann P, Lawson A, Morel O, Ohana M, Roy C, Gangi A, Germain P, Kostakou P, Dagre A, Trifou E, Rodis I, Kostopoulos V, Olympios CD, Guaricci AI, Verdecchia M, Andreini D, Guglielmo M, Baggiano A, Beltrama V, Ferro G, Carita' P, Pepi M, Krljanac G, Savic L, Asanin M, Matovic D, Stepanovic J, Stankovic G, Mrdovic I, Terrizzi A, Trio O, Oteri A, D'amico G, Ioppolo A, Nucifora G, Zucco M, Sergi M, Nicotera A, Boretti I, Carerj S, Zito C, Teixeira R, Reis L, Dinis P, Fernandes A, Caetano F, Almeida I, Costa M, Goncalves L, Reskovic Luksic V, Baricevic Z, Dosen D, Pasalic M, Ostojic Z, Brestovac M, Bulum J, Separovic Hanzevacki J, Toutouzas K, Stathogiannis K, Michelongona A, Latsios G, Synetos A, Trantalis G, Kaitozis O, Brili S, Tousoulis D, Liu D, Hu K, Voelker W, Ertl G, Weidemann F, Herrmann S, Gumauskiene B, Drebickaite E, Ereminiene E, Vaskelyte JJ, Calin A, Rosca M, Beladan CC, Enache R, Calin C, Cosei I, Botezatu S, Simion M, Ginghina C, Popescu BA, Rosa I, Marini C, Ancona F, Latib A, Monitorano M, Colombo A, Margonato A, Agricola E. Poster Session 4The imaging examination and quality assessmentP957Economic impact analysis and quality performance of working with cardiovascular sonographers in high-volume echocardiography laboratoryP958Feasibility of temporal super resolution enhancement of echocardiographic images to diagnose cardiac DiseasesP959Remote medical diagnostician project - Achievements and limitation in tele-echocardiographyP960Right atrial remodeling and galectin-3 are associated with functional capacity in patients with pulmonary arterial hypertensionP961Interatrial electromechanical delay assessed by tissue doppler imaging can separate adults with prehypertension from healthy normotensive controlsP962Preliminary results of an extensive echocardiographic pacemaker optimization protocol for cardiac resynchronization therapyP963Left ventricular global and regional myocardial function in patients with double orifice mitral valve after radical correction on atrioventricular septal defectP964Improving quantitation of left ventricular ejection fraction in a tertiary echocardiography lab - marrying (or merging) guidelines and new technologyP965Echocardiographic evaluation of cardiac function and hemodynamics during LVAD-based resuscitation from cardiac arrest - a porcine studyP966Systolic excursion of the right ventricular outflow tract as a marker of right ventricular dysfunctionP967The impact of the new 2016 ASE/EACVI recommendations in the prevalence and grades of diastolic dysfunction: an analysis from the general populationP968Differential microRNA-21 and microRNA-133 gene expression levels in peripheral blood mononuclear cells from patients with heart failure with preserved ejection fractionP969CMR evaluation of cardiac thrombi and masses by T1 and T2 mapping : an observational studyP970Effect of coronary artery ectasia on left ventricular deformation mechanics. A 2D Speckle Tracking Echocardiography studyP971Diagnostic performance of stress Echo, SPECT, PET, stress CMR, CTCA, CTP and FFRCT for the assessment of CAD versus invasive FFR: a metaanalysisP972Utility of early assessment of myocardial mechanics in STEMI patients treated by primary percutaneous coronary intervention to predict major adverse cardiac events during the first 12 months of folloP973Role of left atrial reservoir in the prediction of increased left ventricular filling pressures in patients with ST-segment elevation myocardial infarctionP974Does the left ventricle ejection fraction improves the Grace risk score accuracy? P975Can we predict significant coronary stenosis using regional strain analysis in non-ST elevation acute coronary syndrome?P976Persistence of pulmonary hypertension after transcatheter aortic valve replacement: incidence and prognostic impactP977Global longitudinal strain is an independent predictor of all cause mortality in patients with severe aortic valve stenosis undergoing valve replacement or treated conservativallyP978Contribution of left ventricular diastolic dysfunction and myocardial fibrosis to pulmonary hypertension in severe aortic stenosisP979Left atrial dysfunction as a determinant of pulmonary hypertension in patients with isolated severe aortic stenosis and preserved left ventricular ejection fractionP980Intraprocedural monitoring protocol using routine transthoracic echocardiography with backup transesophageal probe in transcatheter aortic valve replacement: a single center experience. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
O'Rourke C, Shelton G, Hutcheson JD, Burke MF, Martyn T, Thayer TE, Shakartzi HR, Buswell MD, Tainsh RE, Yu B, Bagchi A, Rhee DK, Wu C, Derwall M, Buys ES, Yu PB, Bloch KD, Aikawa E, Bloch DB, Malhotra R. Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation. J Vis Exp 2016. [PMID: 27284788 DOI: 10.3791/54017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in the world. Atherosclerotic plaques, consisting of lipid-laden macrophages and calcification, develop in the coronary arteries, aortic valve, aorta, and peripheral conduit arteries and are the hallmark of cardiovascular disease. In humans, imaging with computed tomography allows for the quantification of vascular calcification; the presence of vascular calcification is a strong predictor of future cardiovascular events. Development of novel therapies in cardiovascular disease relies critically on improving our understanding of the underlying molecular mechanisms of atherosclerosis. Advancing our knowledge of atherosclerotic mechanisms relies on murine and cell-based models. Here, a method for imaging aortic calcification and macrophage infiltration using two spectrally distinct near-infrared fluorescent imaging probes is detailed. Near-infrared fluorescent imaging allows for the ex vivo quantification of calcification and macrophage accumulation in the entire aorta and can be used to further our understanding of the mechanistic relationship between inflammation and calcification in atherosclerosis. Additionally, a method for isolating and culturing animal aortic vascular smooth muscle cells and a protocol for inducing calcification in cultured smooth muscle cells from either murine aortas or from human coronary arteries is described. This in vitro method of modeling vascular calcification can be used to identify and characterize the signaling pathways likely important for the development of vascular disease, in the hopes of discovering novel targets for therapy.
Collapse
Affiliation(s)
- Caitlin O'Rourke
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Georgia Shelton
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital
| | - Joshua D Hutcheson
- Cardiovascular Division, Brigham and Women's Hospital; Harvard Medical School
| | - Megan F Burke
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital
| | - Trejeeve Martyn
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Timothy E Thayer
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital
| | - Hannah R Shakartzi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Mary D Buswell
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Robert E Tainsh
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital
| | - Binglan Yu
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Aranya Bagchi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Harvard Medical School
| | - David K Rhee
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Connie Wu
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Matthias Derwall
- Department of Anesthesiology, Uniklinik RWTH Aachen, RWTH Aachen University
| | - Emmanuel S Buys
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Paul B Yu
- Cardiovascular Division, Brigham and Women's Hospital; Harvard Medical School
| | - Kenneth D Bloch
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School
| | - Elena Aikawa
- Cardiovascular Division, Brigham and Women's Hospital; Harvard Medical School
| | - Donald B Bloch
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital; Department of Anesthesiology, Uniklinik RWTH Aachen, RWTH Aachen University; Center for Immunology and Inflammatory Diseases and the Division of Rheumatology, Allergy, and Immunology of the Department of Medicine, Massachusetts General Hospital
| | - Rajeev Malhotra
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital; Harvard Medical School;
| |
Collapse
|
19
|
Abstract
Quantification of vascular lesions in models of vascular calcification is crucial for testing novel treatments, but remains a challenging endeavor. Conventional methods include Oil-Red-O staining of whole tissue samples, calcium quantification in incinerated samples, or stereoisometric histologic processing. While most techniques offer fairly high levels of reliability, all of them share the fact that samples are not available for other assays following the analysis, as tissue is altered or destroyed in the course of the procedure. Furthermore, none is capable of measuring both calcification and inflammation at the same time. Here we present a novel technique for the simultaneous quantification of vascular inflammation and calcification, after which samples are still available for further histologic processing.
Collapse
Affiliation(s)
- Matthias Derwall
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
| |
Collapse
|
20
|
Brücken A, Derwall M, Bleilevens C, Stoppe C, Götzenich A, Gaisa NT, Weis J, Nolte KW, Rossaint R, Ichinose F, Fries M. Brief inhalation of nitric oxide increases resuscitation success and improves 7-day-survival after cardiac arrest in rats: a randomized controlled animal study. Crit Care 2015; 19:408. [PMID: 26577797 PMCID: PMC4650396 DOI: 10.1186/s13054-015-1128-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/04/2015] [Indexed: 12/22/2022]
Abstract
Introduction Inhaled nitric oxide (iNO) improves outcomes when given post systemic ischemia/reperfusion injury. iNO given during cardiopulmonary resuscitation (CPR) may therefore improve return of spontaneous circulation (ROSC) rates and functional outcome after cardiac arrest (CA). Methods Thirty male Sprague-Dawley rats were subjected to 10 minutes of CA and at least 3 minutes of CPR. Animals were randomized to receive either 0 (n = 10, Control), 20 (n = 10, 20 ppm), or 40 (n = 10, 40 ppm) ppm iNO during CPR until 30 minutes after ROSC. A neurological deficit score was assessed daily for seven days following the experiment. On day 7, brains, hearts, and blood were sampled for histological and biochemical evaluation. Results During CPR, 20 ppm iNO significantly increased diastolic arterial pressure (Control: 57 ± 5.04 mmHg; 20 ppm: 71.57 ± 57.3 mmHg, p < 0.046) and decreased time to ROSC (Control: 842 ± 21 s; 20 ppm: 792 ± 5 s, (p = 0.02)). Thirty minutes following ROSC, 20 ppm iNO resulted in an increase in mean arterial pressure (Control: 83 ± 4 mmHg; 20 ppm: 98 ± 4 mmHg, p = 0.035), a less pronounced rise in lactate and inflammatory cytokine levels, and attenuated cardiac damage. Inhalation of NO at 20 ppm improved neurological outcomes in rats 2 to 7 days after CA and CPR. This translated into increases in 7 day survival (Control: 4; 20 ppm: 10; 40 ppm 6, (p ≤ 0.05 20 ppm vs Control and 40 ppm). Conclusions Our study revealed that breathing NO during CPR markedly improved resuscitation success, 7-day neurological outcomes and survival in a rat model of VF-induced cardiac arrest and CPR. These results support the beneficial effects of NO inhalation after cardiac arrest and CPR.
Collapse
Affiliation(s)
- Anne Brücken
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Matthias Derwall
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Christian Bleilevens
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Christian Stoppe
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Andreas Götzenich
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Nadine T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Joachim Weis
- Institute for Neuropathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Kay Wilhelm Nolte
- Institute for Neuropathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Michael Fries
- Department of Anesthesiology, St. Vincenz Hospital Limburg, Auf dem Schafsberg, 65549, Limburg, Germany.
| |
Collapse
|
21
|
Derwall M, Ebeling A, Nolte KW, Weis J, Rossaint R, Ichinose F, Nix C, Fries M, Brücken A. Inhaled nitric oxide improves transpulmonary blood flow and clinical outcomes after prolonged cardiac arrest: a large animal study. Crit Care 2015; 19:328. [PMID: 26369409 PMCID: PMC4570752 DOI: 10.1186/s13054-015-1050-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/26/2015] [Indexed: 11/10/2022]
Abstract
Introduction The probability to achieve a return of spontaneous circulation (ROSC) after cardiac arrest can be improved by optimizing circulation during cardiopulomonary resuscitation using a percutaneous left ventricular assist device (iCPR). Inhaled nitric oxide may facilitate transpulmonary blood flow during iCPR and may therefore improve organ perfusion and outcome. Methods Ventricular fibrillation was electrically induced in 20 anesthetized male pigs. Animals were left untreated for 10 minutes before iCPR was attempted. Subjects received either 20 ppm of inhaled nitric oxide (iNO, n = 10) or 0 ppm iNO (Control, n = 10), simultaneously started with iCPR until 5 hours following ROSC. Animals were weaned from the respirator and followed up for five days using overall performance categories (OPC) and a spatial memory task. On day six, all animals were anesthetized again, and brains were harvested for neurohistopathologic evaluation. Results All animals in both groups achieved ROSC. Administration of iNO markedly increased iCPR flow during CPR (iNO: 1.81 ± 0.30 vs Control: 1.64 ± 0.51 L/min, p < 0.001), leading to significantly higher coronary perfusion pressure (CPP) during the 6 minutes of CPR (25 ± 13 vs 16 ± 6 mmHg, p = 0.002). iNO-treated animals showed significantly lower S-100 serum levels thirty minutes post ROSC (0.26 ± 0.09 vs 0.38 ± 0.15 ng/mL, p = 0.048), as well as lower blood glucose levels 120–360 minutes following ROSC. Lower S-100 serum levels were reflected by superior clinical outcome of iNO-treated animals as estimated with OPC (3 ± 2 vs. 5 ± 1, p = 0.036 on days 3 to 5). Three out of ten iNO-treated, but none of the Control animals were able to successfully participate in the spatial memory task. Neurohistopathological examination of vulnerable cerebral structures revealed a trend towards less cerebral lesions in neocortex, archicortex, and striatum in iNO-treated animals compared to Controls. Conclusions In pigs resuscitated with mechanically-assisted CPR from prolonged cardiac arrest, the administration of 20 ppm iNO during and following iCPR improved transpulmonary blood flow, leading to improved clinical neurological outcomes.
Collapse
Affiliation(s)
- Matthias Derwall
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Andreas Ebeling
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Kay Wilhelm Nolte
- Institute for Neuropathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Joachim Weis
- Institute for Neuropathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Fumito Ichinose
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Christoph Nix
- Abiomed Europe GmbH, Neuenhofer Weg 3, D-52074, Aachen, Germany.
| | - Michael Fries
- Department of Anesthesiology, St. Vincenz Hospital Limburg, Auf dem Schafsberg, 65549, Limburg, Germany.
| | - Anne Brücken
- Department of Anesthesiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| |
Collapse
|
22
|
Derwall M, Brücken A, Bleilevens C, Ebeling A, Föhr P, Rossaint R, Kern KB, Nix C, Fries M. Doubling survival and improving clinical outcomes using a left ventricular assist device instead of chest compressions for resuscitation after prolonged cardiac arrest: a large animal study. Crit Care 2015; 19:123. [PMID: 25886909 PMCID: PMC4407317 DOI: 10.1186/s13054-015-0864-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/06/2015] [Indexed: 11/15/2022]
Abstract
Introduction Despite improvements in pre-hospital and post-arrest critical care, sudden cardiac arrest (CA) remains one of the leading causes of death. Improving circulation during cardiopulmonary resuscitation (CPR) may improve survival rates and long-term clinical outcomes after CA. Methods In a porcine model, we compared standard CPR (sCPR; n =10) with CPR using an intravascular cardiac assist device without additional chest compressions (iCPR; n =10) following 10 minutes of electrically induced ventricular fibrillation (VF). In a separate crossover experiment, 10 additional pigs were subjected to 10 minutes of VF and 6 minutes of sCPR; the iCPR device was then implanted if a return of spontaneous circulation (ROSC) was not achieved using sCPR. Animals were evaluated in respect to intra- and post-arrest hemodynamics, survival, functional outcome and cerebral and myocardial lesions following CPR. We hypothesized that iCPR would result in more frequent ROSC and better functional recovery than sCPR. Results iCPR produced a mean flow of 1.36 ± 0.02 L/min, leading to significantly higher coronary perfusion pressure (CPP) values during the early period of CPR (22 ± 10 mmHg vs. 9 ± 5 mmHg, P ≤0.01, 1 minute after start of CPR; 20 ± 11 mmHg vs. 10 ± 7 mmHg, P =0.03, 2 minutes after start of CPR), resulting in high ROSC rates (100% in iCPR vs. 50% in sCPR animals; P =0.03). iCPR animals showed significantly lower serum S100 levels at 10 and 30 minutes following ROSC (3.5 ± 0.6 ng/ml vs. 7.4 ± 3.0 ng/ml 30 minutes after ROSC; P ≤0.01), as well as superior clinical outcomes based on overall performance categories (2.9 ± 1.0 vs. 4.6 ± 0.8 on day 1; P ≤0.01). In crossover experiments, 80% of animals required treatment with iCPR after failed sCPR. Notably, ROSC was still achieved in six of the remaining eight animals (75%) after a total of 22.8 ± 5.1 minutes of ischemia. Conclusions In a model of prolonged cardiac arrest, the use of iCPR instead of sCPR improved CPP and doubled ROSC rates, translating into improved clinical outcomes.
Collapse
Affiliation(s)
- Matthias Derwall
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| | - Anne Brücken
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| | - Christian Bleilevens
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| | - Andreas Ebeling
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| | - Philipp Föhr
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| | - Rolf Rossaint
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| | - Karl B Kern
- Division of Cardiology, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA.
| | - Christoph Nix
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, D-52074, Germany.
| | - Michael Fries
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstrasse 30, Aachen, D-52074, Germany.
| |
Collapse
|
23
|
Malhotra R, Burke MF, Martyn T, Shakartzi HR, Thayer TE, O’Rourke C, Li P, Derwall M, Spagnolli E, Kolodziej SA, Hoeft K, Mayeur C, Jiramongkolchai P, Kumar R, Buys ES, Yu PB, Bloch KD, Bloch DB. Inhibition of bone morphogenetic protein signal transduction prevents the medial vascular calcification associated with matrix Gla protein deficiency. PLoS One 2015; 10:e0117098. [PMID: 25603410 PMCID: PMC4300181 DOI: 10.1371/journal.pone.0117098] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Matrix Gla protein (MGP) is reported to inhibit bone morphogenetic protein (BMP) signal transduction. MGP deficiency is associated with medial calcification of the arterial wall, in a process that involves both osteogenic transdifferentiation of vascular smooth muscle cells (VSMCs) and mesenchymal transition of endothelial cells (EndMT). In this study, we investigated the contribution of BMP signal transduction to the medial calcification that develops in MGP-deficient mice. APPROACH AND RESULTS MGP-deficient mice (MGP(-/-)) were treated with one of two BMP signaling inhibitors, LDN-193189 or ALK3-Fc, beginning one day after birth. Aortic calcification was assessed in 28-day-old mice by measuring the uptake of a fluorescent bisphosphonate probe and by staining tissue sections with Alizarin red. Aortic calcification was 80% less in MGP(-/-) mice treated with LDN-193189 or ALK3-Fc compared with vehicle-treated control animals (P<0.001 for both). LDN-193189-treated MGP(-/-) mice survived longer than vehicle-treated MGP(-/-) mice. Levels of phosphorylated Smad1/5 and Id1 mRNA (markers of BMP signaling) did not differ in the aortas from MGP(-/-) and wild-type mice. Markers of EndMT and osteogenesis were increased in MGP(-/-) aortas, an effect that was prevented by LDN-193189. Calcification of isolated VSMCs was also inhibited by LDN-193189. CONCLUSIONS Inhibition of BMP signaling leads to reduced vascular calcification and improved survival in MGP(-/-) mice. The EndMT and osteogenic transdifferentiation associated with MGP deficiency is dependent upon BMP signaling. These results suggest that BMP signal transduction has critical roles in the development of vascular calcification in MGP-deficient mice.
Collapse
Affiliation(s)
- Rajeev Malhotra
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Megan F. Burke
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Trejeeve Martyn
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hannah R. Shakartzi
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Timothy E. Thayer
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Caitlin O’Rourke
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pingcheng Li
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Matthias Derwall
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Anesthesiology, Uniklinik Aachen, RWTH Aachen University, Aachen, Germany
| | - Ester Spagnolli
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Starsha A. Kolodziej
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Konrad Hoeft
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Claire Mayeur
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pawina Jiramongkolchai
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Ravindra Kumar
- Acceleron Pharma, Inc. Cambridge, MA, United States of America
| | - Emmanuel S. Buys
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Paul B. Yu
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kenneth D. Bloch
- Cardiovascular Research Center and Cardiology Division of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Donald B. Bloch
- Anesthesia Center for Critical Care Research of the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Center for Immunology and Inflammatory Diseases and the Division of Rheumatology, Allergy, and Immunology of the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| |
Collapse
|
24
|
Derwall M, Brücken A, Fries M. New Strategies to Improve Outcome After Cardiac Arrest. Resuscitation 2014. [DOI: 10.1007/978-88-470-5507-0_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Leyton PA, Beppu H, Pappas A, Martyn TM, Derwall M, Baron DM, Galdos R, Bloch DB, Bloch KD. Deletion of the sequence encoding the tail domain of the bone morphogenetic protein type 2 receptor reveals a bone morphogenetic protein 7-specific gain of function. PLoS One 2013; 8:e76947. [PMID: 24116187 PMCID: PMC3792867 DOI: 10.1371/journal.pone.0076947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022] Open
Abstract
The bone morphogenetic protein (BMP) type II receptor (BMPR2) has a long cytoplasmic tail domain whose function is incompletely elucidated. Mutations in the tail domain of BMPR2 are found in familial cases of pulmonary arterial hypertension. To investigate the role of the tail domain of BMPR2 in BMP signaling, we generated a mouse carrying a Bmpr2 allele encoding a non-sense mediated decay-resistant mutant receptor lacking the tail domain of Bmpr2. We found that homozygous mutant mice died during gastrulation, whereas heterozygous mice grew normally without developing pulmonary arterial hypertension. Using pulmonary artery smooth muscle cells (PaSMC) from heterozygous mice, we determined that the mutant receptor was expressed and retained its ability to transduce BMP signaling. Heterozygous PaSMCs exhibited a BMP7‑specific gain of function, which was transduced via the mutant receptor. Using siRNA knockdown and cells from conditional knockout mice to selectively deplete BMP receptors, we observed that the tail domain of Bmpr2 inhibits Alk2‑mediated BMP7 signaling. These findings suggest that the tail domain of Bmpr2 is essential for normal embryogenesis and inhibits Alk2‑mediated BMP7 signaling in PaSMCs.
Collapse
MESH Headings
- Activin Receptors, Type I/genetics
- Activin Receptors, Type I/metabolism
- Activin Receptors, Type II/genetics
- Activin Receptors, Type II/metabolism
- Animals
- Binding Sites/genetics
- Bone Morphogenetic Protein 4/pharmacology
- Bone Morphogenetic Protein 7/pharmacology
- Bone Morphogenetic Protein Receptors, Type II/genetics
- Bone Morphogenetic Protein Receptors, Type II/metabolism
- Cells, Cultured
- Familial Primary Pulmonary Hypertension
- Gene Expression/drug effects
- Genotype
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Immunoblotting
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Microscopy, Confocal
- Muscle, Smooth, Vascular/cytology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Pulmonary Artery/cytology
- RNA Interference
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Deletion
- Smad6 Protein/genetics
- Smad6 Protein/metabolism
Collapse
Affiliation(s)
- Patricio A. Leyton
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Hideyuki Beppu
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Clinical Laboratory and Molecular Pathology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Toyama Prefecture, Japan
| | - Alexandra Pappas
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Trejeeve M. Martyn
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Matthias Derwall
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Uniklinik Aachen, RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany
| | - David M. Baron
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anesthesia, General Intensive Care, and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Rita Galdos
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Donald B. Bloch
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kenneth D. Bloch
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Cardiovascular Research Center, Cardiology Division of the Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
26
|
Ristagno G, Fries M, Brunelli L, Fumagalli F, Bagnati R, Russo I, Staszewsky L, Masson S, Li Volti G, Zappalà A, Derwall M, Brücken A, Pastorelli R, Latini R. Early kynurenine pathway activation following cardiac arrest in rats, pigs, and humans. Resuscitation 2013; 84:1604-10. [PMID: 23774325 DOI: 10.1016/j.resuscitation.2013.06.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 12/28/2022]
Abstract
AIM OF THE STUDY Kynurenine pathway (KP) is a major route of the tryptophan (TRP) catabolism. In the present study, TRP and KP metabolites concentrations were measured in plasma from rats, pigs and humans after cardiac arrest (CA) in order to assess KP activation and its potential role in post-resuscitation outcome. METHODS Plasma was obtained from: (A) 24 rats, subjected to 6 min CA and 6 min of cardiopulmonary resuscitation (CPR); (B) 10 pigs, subjected to 10 min CA and 5 min CPR; and (C) 3 healthy human volunteers and 5 patients resuscitated from CA. KP metabolites were quantified by liquid chromatography multiple reaction monitoring mass spectrometry. Assessments were available at baseline, and 1-4h, and 3-5 days post-CA. RESULTS KP was activated after CA in rats, pigs, and humans. Decreases in TRP occurred during the post-resuscitation period and were accompanied by significant increases in its major metabolites, 3-hydroxyanthranilic acid (3-HAA) and kynurenic acid in each species, that persisted up to 3-5 days post-CA (p<0.01). In rats, changes in KP metabolites reflected changes in post-resuscitation myocardial function. In pigs, changes in TRP and increases in 3-HAA were significanlty related to the severity of cerebral histopathogical injuries. In humans, KP activation was observed, together with systemic inflammation. Post-CA increases in 3-HAA were greater in patients that did not survive. CONCLUSION In this fully translational investigation, the KP was activated early following resuscitation from CA in rats, pigs, and humans, and might have contributed to post-resuscitation outcome.
Collapse
Affiliation(s)
- Giuseppe Ristagno
- Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Derwall M, Fries M. Advances in brain resuscitation: beyond hypothermia. Crit Care Clin 2012; 28:271-81. [PMID: 22433487 DOI: 10.1016/j.ccc.2011.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Matthias Derwall
- Department of Anesthesiology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
| | | |
Collapse
|
28
|
Derwall M, Malhotra R, Lai CS, Beppu Y, Aikawa E, Seehra JS, Zapol WM, Bloch KD, Yu PB. Inhibition of bone morphogenetic protein signaling reduces vascular calcification and atherosclerosis. Arterioscler Thromb Vasc Biol 2012; 32:613-22. [PMID: 22223731 DOI: 10.1161/atvbaha.111.242594] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The expression of bone morphogenetic proteins (BMPs) is enhanced in human atherosclerotic and calcific vascular lesions. Although genetic gain- and loss-of-function experiments in mice have supported a causal role of BMP signaling in atherosclerosis and vascular calcification, it remains uncertain whether BMP signaling might be targeted pharmacologically to ameliorate both of these processes. METHODS AND RESULTS We tested the impact of pharmacological BMP inhibition on atherosclerosis and calcification in LDL receptor-deficient (LDLR-/-) mice. LDLR-/- mice fed a high-fat diet developed abundant vascular calcification within 20 weeks. Prolonged treatment of LDLR-/- mice with the small molecule BMP inhibitor LDN-193189 was well-tolerated and potently inhibited development of atheroma, as well as associated vascular inflammation, osteogenic activity, and calcification. Administration of recombinant BMP antagonist ALK3-Fc replicated the antiatherosclerotic and anti-inflammatory effects of LDN-193189. Treatment of human aortic endothelial cells with LDN-193189 or ALK3-Fc abrogated the production of reactive oxygen species induced by oxidized LDL, a known early event in atherogenesis. Unexpectedly, treatment of mice with LDN-193189 lowered LDL serum cholesterol by 35% and markedly decreased hepatosteatosis without inhibiting HMG-CoA reductase activity. Treatment with BMP2 increased, whereas LDN-193189 or ALK3-Fc inhibited apolipoprotein B100 secretion in HepG2 cells, suggesting that BMP signaling contributes to the regulation of cholesterol biosynthesis. CONCLUSION These results definitively implicate BMP signaling in atherosclerosis and calcification, while uncovering a previously unidentified role for BMP signaling in LDL cholesterol metabolism. BMP inhibition may be helpful in the treatment of atherosclerosis and associated vascular calcification.
Collapse
Affiliation(s)
- Matthias Derwall
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, the Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Derwall M, Francis RCE, Kida K, Bougaki M, Crimi E, Adrie C, Zapol WM, Ichinose F. Administration of hydrogen sulfide via extracorporeal membrane lung ventilation in sheep with partial cardiopulmonary bypass perfusion: a proof of concept study on metabolic and vasomotor effects. Crit Care 2011; 15:R51. [PMID: 21299857 PMCID: PMC3221981 DOI: 10.1186/cc10016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/15/2010] [Accepted: 02/07/2011] [Indexed: 11/28/2022] Open
Abstract
Introduction Although inhalation of 80 parts per million (ppm) of hydrogen sulfide (H2S) reduces metabolism in mice, doses higher than 200 ppm of H2S were required to depress metabolism in rats. We therefore hypothesized that higher concentrations of H2S are required to reduce metabolism in larger mammals and humans. To avoid the potential pulmonary toxicity of H2S inhalation at high concentrations, we investigated whether administering H2S via ventilation of an extracorporeal membrane lung (ECML) would provide means to manipulate the metabolic rate in sheep. Methods A partial venoarterial cardiopulmonary bypass was established in anesthetized, ventilated (fraction of inspired oxygen = 0.5) sheep. The ECML was alternately ventilated with air or air containing 100, 200, or 300 ppm H2S for intervals of 1 hour. Metabolic rate was estimated on the basis of total CO2 production (V˙CO2) and O2 consumption (V˙O2). Continuous hemodynamic monitoring was performed via indwelling femoral and pulmonary artery catheters. Results V˙CO2, V˙O2, and cardiac output ranged within normal physiological limits when the ECML was ventilated with air and did not change after administration of up to 300 ppm H2S. Administration of 100, 200 and 300 ppm H2S increased pulmonary vascular resistance by 46, 52 and 141 dyn·s/cm5, respectively (all P ≤ 0.05 for air vs. 100, 200 and 300 ppm H2S, respectively), and mean pulmonary artery pressure by 4 mmHg (P ≤ 0.05), 3 mmHg (n.s.) and 11 mmHg (P ≤ 0.05), respectively, without changing pulmonary capillary wedge pressure or cardiac output. Exposure to 300 ppm H2S decreased systemic vascular resistance from 1,561 ± 553 to 870 ± 138 dyn·s/cm5 (P ≤ 0.05) and mean arterial pressure from 121 ± 15 mmHg to 66 ± 11 mmHg (P ≤ 0.05). In addition, exposure to 300 ppm H2S impaired arterial oxygenation (PaO2 114 ± 36 mmHg with air vs. 83 ± 23 mmHg with H2S; P ≤ 0.05). Conclusions Administration of up to 300 ppm H2S via ventilation of an extracorporeal membrane lung does not reduce V˙CO2 and V˙O2, but causes dose-dependent pulmonary vasoconstriction and systemic vasodilation. These results suggest that administration of high concentrations of H2S in venoarterial cardiopulmonary bypass circulation does not reduce metabolism in anesthetized sheep but confers systemic and pulmonary vasomotor effects.
Collapse
Affiliation(s)
- Matthias Derwall
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Bickenbach J, Schälte G, Beckers S, Fries M, Derwall M, Rossaint R. The intuitive use of laryngeal airway tools by first year medical students. BMC Emerg Med 2009; 9:18. [PMID: 19772608 PMCID: PMC2754427 DOI: 10.1186/1471-227x-9-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 09/22/2009] [Indexed: 11/10/2022] Open
Abstract
Background Providing a secured airway is of paramount importance in cardiopulmonary resuscitation. Although intubating the trachea is yet seen as gold standard, this technique is still reserved to experienced healthcare professionals. Compared to bag-valve facemask ventilation, however, the insertion of a laryngeal mask airway offers the opportunity to ventilate the patient effectively and can also be placed easily by lay responders. Obviously, it might be inserted without detailed background knowledge. The purpose of the study was to investigate the intuitive use of airway devices by first-year medical students as well as the effect of a simple, but well-directed training programme. Retention of skills was re-evaluated six months thereafter. Methods The insertion of a LMA-Classic and a LMA-Fastrach performed by inexperienced medical students was compared in an airway model. The improvement on their performance after a training programme of overall two hours was examined afterwards. Results Prior to any instruction, mean time to correct placement was 55.5 ± 29.6 s for the LMA-Classic and 38.1 ± 24.9 s for the LMA-Fastrach. Following training, time to correct placement decreased significantly with 22.9 ± 13.5 s for the LMA-Classic and 22.9 ± 19.0 s for the LMA-Fastrach, respectively (p < 0.05). After six months, the results are comparable prior (55.6 ± 29.9 vs 43.1 ± 34.7 s) and after a further training period (23.5 ± 13.2 vs 26.6 ± 21.6, p < 0.05). Conclusion Untrained laypersons are able to use different airway devices in a manikin and may therefore provide a secured airway even without having any detailed background knowledge about the tool. Minimal theoretical instruction and practical skill training can improve their performance significantly. However, refreshment of knowledge seems justified after six months.
Collapse
Affiliation(s)
- Johannes Bickenbach
- Department of Surgical Intensive Care, University Hospital RWTH Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
31
|
Derwall M, Stoppe C, Brücken D, Rossaint R, Fries M. Changes in S-100 protein serum levels in survivors of out-of-hospital cardiac arrest treated with mild therapeutic hypothermia: a prospective, observational study. Crit Care 2009; 13:R58. [PMID: 19368739 PMCID: PMC2689505 DOI: 10.1186/cc7785] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 03/19/2009] [Accepted: 04/16/2009] [Indexed: 01/07/2023]
Abstract
Introduction Knowledge about the influence of current neuroprotective interventions on prognostic markers after survival from cardiac arrest is lacking. This study aimed to investigate the effects of mild therapeutic hypothermia on the release of the astroglial protein S-100 after cardiopulmonary resuscitation (CPR) in survivors of out-of-hospital cardiac arrest. Methods This was a prospective, observational study performed during a two-year period, involving medical emergency services and five collaborating hospitals at the city of Aachen, Germany. Sixty-eight subjects were enrolled by the emergency physician on duty by taking blood samples after successful attempts at resuscitation with return of spontaneous circulation (ROSC), followed by samples at 6, 12, 24, 72 and 120 hours post ROSC by the appropriate intensive care unit staff. Depending on the decision of the attending physician, subjects were cooled down to 33°C (n = 37) for 24 hours or were held at 37°C (n = 31). Patients were tracked for estimating mortality and gross neurological outcome for 14 days. Results S-100 levels in patients not receiving mild therapeutic hypothermia (normothermia (NT)) showed equivalent numbers as compared with cooled patients (mild therapeutic hypothermia (MTH)) on baseline (NT = 1.38 μg/l versus MTH = 1.30 μg/l; P = 0.886). S-100 levels on baseline were significantly lower in patients with a good neurological outcome at 14 days after the event in comparison to their peers with adverse outcome (P = 0.014). Although the difference in S-100 levels of MTH patients with adverse or favourable neurological outcome reached statistical significance, it did not in NT patients. Conclusions Although the predictive power of S-100 levels were best on admission but not at later time points, MTH had no influence on S-100 serum levels in survivors of non-traumatic out-of-hospital cardiac arrest in the particular setting of this investigation.
Collapse
Affiliation(s)
- Matthias Derwall
- Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | | | | | | | | |
Collapse
|
32
|
Derwall M, Coburn M, Rex S, Hein M, Rossaint R, Fries M. Xenon: recent developments and future perspectives. Minerva Anestesiol 2009; 75:37-45. [PMID: 18475253] [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: 05/26/2023]
Abstract
The noble gas xenon exerts favorable anesthetic properties along with remarkable hemodynamic stability in healthy patients undergoing elective surgery. Recent investigations documented that it does not prolong the duration of widely used neuromuscular blocking agents, including mivacurium and rocuronium. Some studies also suggest reduced neurocognitive compromise in the very early phase after general anesthesia. These properties differ from those observed for conventional inhalational anesthetics like isoflurane, desflurane and sevoflurane. However, a wider use of xenon in daily clinical routine has been limited owing to its higher price and technical restraints regarding economic delivery. Although there are controversial opinions, xenon seems to exert its main anesthetic features via the glutamate receptor. Recently, a novel binding cavity on the NMDA-subtype glutamate receptor has been elucidated that is occupied by xenon as well as isoflurane. Studies utilizing advanced imaging technologies have furthermore revealed that xenon markedly suppresses cerebral blood flow and glucose metabolism in distinct regions of the human brain. These investigations promise to further the understanding of the basic mechanisms underlying the induction and maintenance of anesthesia in general. Results from in vitro studies and various animal models have consistently demonstrated organoprotective properties of xenon, mainly in settings of ischemia and reperfusion injury. Interestingly, these effects have frequently been observed at subanesthetic concentrations and seem to be synergistic when used in combination with therapeutic hypothermia. Future studies will have to prove whether the high costs of xenon administration might be outweighed by its ability to substantially reduce the sequelae of myocardial and cerebral ischemia.
Collapse
Affiliation(s)
- M Derwall
- Department of Anesthesiology, University Hospital Aachen, RWTH Aachen, Germany.
| | | | | | | | | | | |
Collapse
|
33
|
Beckers SK, Fries M, Bickenbach J, Skorning MH, Derwall M, Kuhlen R, Rossaint R. Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators. Resuscitation 2007; 72:444-50. [PMID: 17188417 DOI: 10.1016/j.resuscitation.2006.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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: 03/26/2006] [Revised: 07/21/2006] [Accepted: 08/01/2006] [Indexed: 11/29/2022]
Abstract
AIM OF THE STUDY There is consent that the use of automated external defibrillators (AED) by laypersons improves survival rates in case of cardiac arrest, but no evident consensus exists on the content and duration of training for this purpose. Acceptance of the implementation of Public Access Defibrillation programmes will depend on practical and target-oriented training concepts. The aim of this prospective randomised interventional study was to evaluate long-term effects of a specific, minimal training programme on using semiautomatic and fully automatic AEDs in simulated cardiac arrest. MATERIALS AND METHODS In a mock cardiac arrest scenario 59 medical students with no specific previous medical education were tested during their first semester at medical school. Students who passed any medical emergency training were excluded. The subjects were evaluated before and after attending specified instructions of 15 min duration and after a period of 6 months. Main end points were time to first shock, electrode-positioning and safety throughout the procedure. RESULTS Mean time to first shock without prior instructions was 77.7+/-17.05 s. After instruction there was a significant improvement to 56.5+/-9.5 s (p<or=0.01) and after 6 months this time had only slightly elongated (59.9+/-8.9 s; p<or=0.01). Initially, correct electrode placement was observed in 84.4%. No difference was found immediately and 6 months after instructions (93.2% and 98.3%). All individuals performed safely. CONCLUSION First year medical students with minimal instruction are able to use semiautomatic as well as fully automatic AED sufficiently fast and safe without prior training. A significant improvement in time to first shock can be detected up to 6 months after receiving non-specific instructions of 15 min duration.
Collapse
Affiliation(s)
- Stefan K Beckers
- Department of Anaesthesiology, University Hospital Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
34
|
Beckers SK, Skorning MH, Fries M, Bickenbach J, Beuerlein S, Derwall M, Kuhlen R, Rossaint R. CPREzy™ improves performance of external chest compressions in simulated cardiac arrest. Resuscitation 2007; 72:100-7. [PMID: 17079067 DOI: 10.1016/j.resuscitation.2006.05.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [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: 05/16/2006] [Revised: 05/21/2006] [Accepted: 05/21/2006] [Indexed: 11/23/2022]
Abstract
AIM OF THE STUDY External chest compression (ECC) is an essential part of cardiopulmonary resuscitation and usually performed without any adjuncts. Although different supportive devices have been developed, none have yet been implemented as a standard procedure to guide rescuers in resuscitation. This study investigates the effects of the CPREzy-pad on ECC performed by first year medical students during simulated cardiac arrest. MATERIALS AND METHODS Two hundred and two subjects were randomised and asked to perform 5 min of single-rescuer-CPR. Group 1 (n = 111) was taught classic ECC, followed by ECC with the CPREzy and was tested in ECC with the CPREzy. Group 2 (n = 91) was taught and tested in classic ECC only. One week later each group was divided: Group 1A was tested in ECC with the CPREzy again; Group 1B was tested in classic ECC. Group 2A was taught and tested in ECC with CPREzy; Group 2B was tested in classic ECC again. Primary endpoints were compression rate (90-110/min) and compression depth (40-50mm). RESULTS Comparing groups 1 and 2, ECC was significantly superior with CPREzy (correct rate: 93.7% versus 19.8%, p < or = 0.01; depth: 71.2% versus 34.1%, p < or = 0.01). The group tested with CPREzy initially 1 week later (2A; n = 36) improved significantly in correct compression rate (19.8% versus 88.9%, p < or = 0.01) and compression depth (34.1% versus 75.0%, p < or = 0.02). The control-group (2B; n = 55) without CPREzy demonstrated poor performance in both evaluations (correct rate: 19.8% versus 25.5%, depth: 34.1% versus 43.6%). CONCLUSION CPREzy as a simple portable and re-usable device is able to improve performance of ECC in simulated cardiac arrest.
Collapse
Affiliation(s)
- Stefan K Beckers
- Department of Aneasthesiology, University Hospital Aachen, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Beckers S, Fries M, Bickenbach J, Derwall M, Kuhlen R, Rossaint R. Minimal instructions improve the performance of laypersons in the use of semiautomatic and automatic external defibrillators. Crit Care 2005; 9:R110-6. [PMID: 15774042 PMCID: PMC1175919 DOI: 10.1186/cc3033] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [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: 09/14/2004] [Revised: 11/01/2004] [Accepted: 11/30/2004] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION There is evidence that use of automated external defibrillators (AEDs) by laypersons improves rates of survival from cardiac arrest, but there is no consensus on the optimal content and duration of training for this purpose. In this study we examined the use of semiautomatic or automatic AEDs by laypersons who had received no training (intuitive use) and the effects of minimal general theoretical instructions on their performance. METHODS In a mock cardiac arrest scenario, 236 first year medical students who had not previously attended any preclinical courses were evaluated in their first study week, before and after receiving prespecified instructions (15 min) once. The primary end-point was the time to first shock for each time point; secondary end-points were correct electrode pad positioning, safety of the procedure and the subjective feelings of the students. RESULTS The mean time to shock for both AED types was 81.2 +/- 19.2 s (range 45-178 s). Correct pad placement was observed in 85.6% and adequate safety in 94.1%. The time to shock after instruction decreased significantly to 56.8 +/- 9.9 s (range 35-95 s; P < or = 0.01), with correct electrode placement in 92.8% and adequate safety in 97%. The students were significantly quicker at both evaluations using the semiautomatic device than with the automatic AED (first evaluation: 77.5 +/- 20.5 s versus 85.2 +/- 17 s, P < or = 0.01; second evaluation: 55 +/- 10.3 s versus 59.6 +/- 9.6 s, P < or = 0.01). CONCLUSION Untrained laypersons can use semiautomatic and automatic AEDs sufficiently quickly and without instruction. After one use and minimal instructions, improvements in practical performance were significant. All tested laypersons were able to deliver the first shock in under 1 min.
Collapse
Affiliation(s)
- Stefan Beckers
- Resident, Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - Michael Fries
- Resident, Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - Johannes Bickenbach
- Resident, Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - Matthias Derwall
- Medical Student, Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - Ralf Kuhlen
- Professor, Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| | - Rolf Rossaint
- Professor and Chairman, Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany
| |
Collapse
|
36
|
|