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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Tag: cardiac arrest (Page 2 of 5)

Predictors of neurological outcome in the emergency department for elderly patients following out-of-hospital restoration of spontaneous circulation

Abstract

Aims. Survival rates for cardiac arrest in acute medicine are higher following out-of-hospital restoration of spontaneous circulation (OH-ROSC). However, data pertaining to OH-ROSC is limited in the elderly population. We aimed to assess the predictors of neurological outcome among elderly patients with OH-ROSC.

Methods. We retrospectively analyzed the data of patients 65 years and older who achieved OH-ROSC and who presented to the emergency department (ED) between 2009 and 2013. The following parameters were considered: age, sex, medical history, vital signs, blood values, initial electrical rhythm, witnessed cardiac arrest, bystander cardiopulmonary resuscitation, resuscitation duration, attempted defibrillation, and neurological outcome. Neurological outcomes were evaluated 3 months after cardiac arrest, using the cerebral performance category (CPC) score, and were classified into two groups: favorable outcome (CPC = 1–2) and unfavorable outcome (CPC = 3–5).

Results. Fifty-five patients were studied, of which 21 and 34 patients were classified as having favorable and unfavorable outcomes, respectively. The following values were associated with favorable outcomes: resuscitation duration, initial cardiac rhythm, base excess, pH, lactate levels, the motor response on the Glasgow Coma Scale (GCS), and the number of patients with GCS ≤8 (p < 0.01). Logistic regression analysis confirmed that motor response scores and lactate levels were independent predictors of neurological outcomes.

Conclusions. Lactate levels and GCS motor response measured immediately at ED arrival are likely to be useful to assess the neurological outcomes among elderly patients with OH-ROSC.

Key words: age, basic life support, cardiac arrest, prediction, resuscitation

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Automated external defibrillator skills among lay people in the region of Koroska: a pilot study

Abstract

Background. In the region of Koroška, there are more and more public spaces equipped with automated external defibrillators which can be used by a witnessed bystander. The aim of this study was to gain insight into the skills required for using automated external defibrillators.

Methods. This was a cross-sectional survey conducted in two family medicine practices. We included volunteers who visited their family doctor during a period of four days. Skills were assessed in a virtual setting using a plastic manikin.

Results. There were 107 participants in the sample, 60.0% were women. Average age of the sample was 47.6±16.8 years. In the practical part (skills testing), the participants earned 2.7 points from a total of 5 points. Younger participants and those who attended a course in basic life support, in the past 10 years, had a significantly higher score.

Conclusion. Lay people need more education regarding skills for using automated external defibrillators.

Key words: automated external defibrillator, basic life support, lay people, survival, cardiac arrest

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A seven-year follow-up of discharged patients after out-of-hospital cardiac arrest with respect to ST-segment elevation myocardial infarction

Abstract

Introduction. The aim of this multicentre prospective study was to describe the seven-year survival of patients, from the region of East Bohemia, after out-of-hospital cardiac arrest (OHCA), occurring between  2002 and  2004. The main focus of this study was on the survival of patients with ST-segment elevated myocardial infarction (STEMI).
Patients and Methods. A total 718 patients  with OHCA were included in the study. Of these patients, 149 were admitted to hospital. The main cohort of our study consisted of 53 patients (41 men; median 59; average 58±13), who survived acute hospitalization. In these patients, STEMI was the main cause of OHCA in 15 cases (28%), whereas without STEMI was found in 38 cases (72%). Patients who survived hospitalization were periodically followed-up at six-monthly intervals.
Results. In the first follow-up year, 42 patients survived (79% of 53 patients), in the third year 38 patients (72%), in the fifth year 33 patients (62%) and in the seventh year 31 patients (59%). Ninety-four percent of patients were in good neurological condition after the seventh follow-up year. The whole period of seven years was survived by 12 (80%) out of 15 patients with STEMI, and by 19 (50%) out of 38 patients without STEMI. In patients who survived the seventh year after STEMI, direct percutaneous coronary intervention was performed in 11 cases.
Conclusions. Fifty-nine percent of patients discharged from hospital after OHCA   survived until the seventh year. The highest rate of survival during this period was seen in patients with STEMI, i.e. in 80%.

 

Key words: cardiac arrest, myocardial infarction, out-of-hospital cardiac arrest, sudden cardiac death, survivors, ventricular fibrillation

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Bilateral Intracerebral hemorrhage following CPR

Abstract

Intracranial hemorrhage is an extremely rare complication following cardiopulmonary resuscitation (CPR). Only a few cases of subarachnoid hemorrhage during the post-resuscitation period have been reported in the literature.
A 55 year-old man, who was resuscitated following a cardiac arrest, sustained an intracranial hemorrhage during the post cardiac arrest period. His brain computerized tomography (CT), performed 4 hours after return of spontaneous circulation, showed no signs of intracranial hemorrhage. However, a brain CT performed 7 days after cardiac arrest revealed a massive intracerebral hemorrhage in both basal ganglia and thalami with an associated subarachnoid hemorrhage.
This paper reports the first case of intracerebral hemorrhages in bilateral basal ganglia and thalami that developed following cardiac arrest and resuscitation.

 

Key words: cardiopulmonary resuscitation (CPR), intracranial hemorrhage, basal ganglia hemorrhage, cardiac arrest

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Terlipressin/adrenaline is better than adrenaline alone in a porcine model of prolonged ventricular fibrillation A randomized controlled study

Abstract

Objectives. Vasopressors have been routinely used in cardiopulmonary resuscitation. Recent data show that terlipressin may restore blood pressure in asphyxial and prolonged arrests but its potential role in ventricular fibrillation (VF) remains unknown. The aim of this study was to compare coronary (CorPP) and cerebral (CPP) perfusion pressures achieved by terlipressin/adrenaline versus placebo/adrenaline in VF.

Methods. Fourteen domestic pigs were randomly assigned into group A and B. After 5 min of untreated VF, compression-only resuscitation was applied for 10 min, followed by advanced life support. Terlipressin in a single-dose of 30 µg·kg-1 was added to the first dose of adrenaline in group A, while placebo was given in group B. CorPP and CPP were calculated from right atrial, aortic and intracerebral pressures. Data were analyzed using repeated measurements ANOVA and a Fisher´s protected LSD post hoc test.

Results. Terlipressin/adrenaline maintained CorPP above 10 mmHg for 17.7 min longer than adrenaline alone (P=0.003) unable to prevent refractory hypotension. CorPP (mean±SD) measured at 35, 45, and 55 min after the onset of VF was 12 ± 4, 11 ± 6, and 10 ± 5 mmHg in the terlipressin group A; and 6 ± 4, 1 ± 5, and -1 ± 5 mmHg in placebo group B (P=0.03, <0.001, and <0.001). CPP measured at the same times was 23 ± 7, 20 ± 7, and 23 ± 7 mmHg in group A; and 13 ± 7, 6 ± 5, and 6 ± 7 mmHg in group B (P=0.01, <0.001, and <0.001).

Conclusion. The study showed that a single dose of terlipressin, when added to adrenaline, was effective for achievement of higher vital organ perfusion pressures compared to adrenaline alone.

Key words: cardiopulmonary resuscitation (CPR), cardiac arrest, terlipressin, vasopressor therapy, cerebral perfusion pressure, coronary perfusion pressure, ventricular fibrillation

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