Complete neurologic recovery in an out-of-hospital cardiac arrest facilitated by initiation of therapeutic hypothermia in a young athlete with an anomalous right coronary artery

2014 ◽  
Vol 26 (3) ◽  
pp. 227-230
Author(s):  
Michael C. Tan ◽  
Douglas B. Coursin
Keyword(s):  
Cardiac Arrest ◽  
Coronary Artery ◽  
Therapeutic Hypothermia ◽  
Right Coronary Artery ◽  
Young Athlete ◽  
Neurologic Recovery ◽  
Hospital Cardiac Arrest

scholarly journals Successful Use of Therapeutic Hypothermia in a Pregnant Patient

2015 ◽  
Vol 42 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Kevin N. Oguayo ◽  
Ola O. Oyetayo ◽  
David Stewart ◽  
Steven M. Costa ◽  
Richard O. Jones
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Multidisciplinary Approach ◽  
Short Term Memory ◽  
Memory Loss ◽  
Pregnant Patient ◽  
The United States ◽  
Successful Outcome ◽  
Neurologic Recovery ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest is a leading cause of death in the United States. Pregnant women are not immune to cardiac arrest, and the treatment of such patients can be difficult. Pregnancy is a relative contraindication to the use of therapeutic hypothermia after cardiac arrest. A 20-year-old woman who was 18 weeks pregnant had an out-of-hospital cardiac arrest. Upon her arrival at the emergency department, she was resuscitated and her circulation returned spontaneously, but her score on the Glasgow Coma Scale was 3. After adequate family discussion of the risks and benefits of therapeutic hypothermia, a decision was made to initiate therapeutic hypothermia per established protocol for 24 hours. The patient was successfully cooled and rewarmed. By the time she was discharged, she had experienced complete neurologic recovery, apart from some short-term memory loss. Subsequently, at 40 weeks, she delivered vaginally a 7-lb 3-oz girl whose Apgar scores were 8 and 9, at 1 and 5 minutes respectively. To our knowledge, this is only the 3rd reported case of a successful outcome following the initiation of therapeutic hypothermia for out-of-hospital cardiac arrest in a pregnant woman. On the basis of this and previous reports of successful outcomes, we recommend that therapeutic hypothermia be considered an option in the management of out-of-hospital cardiac arrest in the pregnant population. To facilitate a successful outcome, a multidisciplinary approach involving cardiology, emergency medicine, obstetrics, and neurology should be used.

scholarly journals Anomalous left coronary artery from the pulmonary artery: a rare cause of an out-of-hospital cardiac arrest in an adult—a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
Madelien V Regeer ◽  
Olga Bondarenko ◽  
Katja Zeppenfeld ◽  
Anastasia D Egorova
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Complication Rates ◽  
Anomalous Left Coronary Artery ◽  
Subcutaneous Icd ◽  
Hospital Cardiac Arrest ◽  
Anomalous Left Coronary

Abstract Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disorder resulting in ischaemia and myocardial infarction which can act as a potential substrate for life-threatening arrhythmias and sudden cardiac death. Case summary A 19-year-old man was admitted to the hospital after successful resuscitation from an out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation occurring during jogging. In the diagnostic work-up of the OHCA, computed tomography identified an ALCAPA. The patient was referred to our tertiary hospital for surgical correction. Direct reimplantation of the left coronary artery in the aorta was performed. During follow-up, 24-h electrocardiogram revealed short episodes of non-sustained ventricular tachycardia (VT). The magnetic resonance imaging at initial admission showed focal wall thinning and transmural late gadolinium enhancement consistent with a previous anterolateral myocardial infarction. Therefore, the aetiology of the OHCA could be due to a scar-related mechanism and not necessarily due to a reversible cause and an implantable cardioverter-defibrillator (ICD) was considered indicated. Given the young age and the lower complication rates, a subcutaneous device was preferred over a transvenous ICD. However, as a subcutaneous ICD (S-ICD) lacks the possibility of anti-tachycardia pacing, programmed electrical stimulation (PES) was performed to test for inducibility of monomorphic, re-entrant VT. After a negative PES, an S-ICD was implanted. Discussion ALCAPA is a potential cause of OHCA in young patients. Some of these patients keep an irreversible substrate for ventricular arrhythmias despite full surgical revascularization and might be candidates for (subcutaneous) ICD implantation.

scholarly journals The effect of video-instructed versus audio-instructed dispatcher-assisted cardiopulmonary resuscitation on patient outcomes following out of hospital cardiac arrest in Seoul

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hee Soon Lee ◽  
Kicheol You ◽  
Jin Pyeong Jeon ◽  
Chulho Kim ◽  
Sungeun Kim
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Elderly Patients ◽  
Discharge Rate ◽  
Neurologic Outcome ◽  
Binary Logistic Regression Analysis ◽  
Video Instruction ◽  
Neurologic Recovery ◽  
Metropolitan City ◽  
Hospital Cardiac Arrest

AbstractWe aimed to investigate whether video-instructed dispatcher-assisted (DA)-cardiopulmonary resuscitation (CPR) improved neurologic recovery and survival to discharge compared to audio-instructed DA-CPR in adult out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city with sufficient experience and facilities. A retrospective cohort study was conducted for adult bystander-witnessed OHCA patients administered DA-CPR due to presumed cardiac etiology between January 1, 2018 and October 31, 2019 in Seoul, Korea. The primary and secondary outcomes were the differences in favorable neurologic outcome and survival to discharge rates in adult OHCA patients in the two instruction groups. Binary logistic regression analysis was performed to identify the outcome predictors after DA-CPR. A total of 2109 adult OHCA patients with DA-CPR were enrolled. Numbers of elderly patients in audio instruction and video instruction were 1260 (73.2%) and 214 (55.3%), respectively. Elderly patients and those outside the home or medical facility were more likely to receive video instruction. Favorable neurologic outcome was observed more in patients who received video-instructed DA-CPR (n = 75, 19.4%) than in patients who received audio-instructed DA-CPR (n = 117, 6.8%). The survival to discharge rate was also higher in video-instructed DA-CPR (n = 105, 27.1%) than in audio-instructed DA-CPR (n = 211, 12.3%). Video-instructed DA-CPR was significantly associated with neurologic recovery (aOR = 2.11, 95% CI 1.48–3.01) and survival to discharge (aOR = 1.81, 95% CI 1.33–2.46) compared to audio-instructed DA-CPR in adult OHCA patients after adjusting for age, gender, underlying diseases and CPR location. Video-instructed DA-CPR was associated with favorable outcomes in adult patients with OHCA in a metropolitan city equipped with sufficient experience and facilities.

scholarly journals Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors

2021 ◽  
Author(s):  
M. van der Graaf ◽  
L. S. D. Jewbali ◽  
J. S. Lemkes ◽  
E. M. Spoormans ◽  
M. van der Ent ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Coronary Occlusion ◽  
Independent Factor ◽  
St Segment Elevation ◽  
St Segment ◽  
Artery Disease ◽  
Chronic Total Coronary Occlusion ◽  
Hospital Cardiac Arrest

Abstract Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event.

scholarly journals Effect of empiric antiarrhythmic therapy in resuscitated out-of-hospital cardiac arrest victims with coronary artery disease

1990 ◽  
Vol 65 (18) ◽  
pp. 1192-1197 ◽  
Author(s):  
Ali R. Moosvi ◽  
Sidney Goldstein ◽  
Sharon VanderBrug Medendorp ◽  
J.Richard Landis ◽  
Robert A. Wolfe ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Antiarrhythmic Therapy ◽  
Artery Disease ◽  
Hospital Cardiac Arrest

Abstract 13131: The Priority of Coronary Arteriography and Therapeutic Hypothermia After Return of Spontaneous Circulation in Patients With Out-of-hospital Cardiac Arrest. the Result of Sos-kanto 2012 Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shuichi Hagiwara ◽  
Kiyohiro Oshima ◽  
Masato Murata ◽  
Makoto Aoki ◽  
Kei Hayashida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Statistical Significance ◽  
Coronary Arteriography ◽  
Spontaneous Circulation ◽  
P Value ◽  
Return Of Spontaneous Circulation ◽  
Overall Performance ◽  
The Mean ◽  
Hospital Cardiac Arrest

Aim: To evaluate the priority of coronary angiography (CAG) and therapeutic hypothermia therapy (TH) after return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). Patients and Methods: SOS-KANTO 2012 study is a prospective, multicenter (69 emergency hospitals) and observational study and includes 16,452 patients with OHCA. Among the cases with ROSC in that study, we intended for patients treated with both CAG and TH within 24 hours after arrival. Those patients were divided into two groups; patients in whom TH was firstly performed (TH group), and the others in whom CAG was firstly done (CAG group). We statistically compared the prognosis between the two groups. SPSS Statistics 22 (IBM, Tokyo, Japan) was used for the statistical analysis. Statistical significance was assumed to be present at a p value of less than 0.05. Result: 233 patients were applied in this study. There were 86 patients in the TH group (M/F: 74/12, mean age; 60.0±15.2 y/o) and 147 in the CAG group (M/F: 126/21, mean age: 63.4±11.1 y/o) respectively, and no significant differences were found in the mean age and M/F ratio between the two groups. The overall performance categories (OPC) one month after ROSC in the both groups were as follows; in the TH group, OPC1: 21 (24.4%), OPC2: 3 (3.5%), OPC3: 7 (8.1%), OPC4: 8 (9.3%), OPC5: 43 (50.0%), unknown: 4 (4.7%), and in the CAG group, OPC1: 38 (25.9%), OPC2: 13 (8.8%), OPC3: 15 (10.2%), OPC4: 18 (12.2%), OPC5: 57 (38.8%), unknown: 6 (4.1%). There were no significant differences in the prognosis one month after ROSC between the two groups. Conclusion: The results which of TH and CAG you give priority to over do not affect the prognosis in patients with OHCA.

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