In-Hospital Cardiac Arrest (DRAFT)

High Level ◽

Hospital Cardiac Arrest ◽

System Organ

In-hospital cardiac arrest (IHCA) is a major public health problem. Despite its prevalence, there remains a paucity of high-level evidence to guide patient management during and after resuscitation from IHCA and most guidelines are extrapolated from studies of out-of-hospital cardiac arrest. This chapter reviews the cornerstones of IHCA management: early recognition, provision of high quality compressions, and early defibrillation of shockable rhythms. It also summarizes key actions in early post-resuscitation care, including multiple system organ support to prevent rearrest and restore hemodynamic stability and prevention of secondary brain injury. Finally, brief attention is given to adjuncts to traditional IHCA resuscitation including thrombolysis, corticosteroids, and extracorporeal circulatory support.

Abstract 246: The Relationship Between Favorable Neurological Outcome in Patients With Out-of-Hospital Cardiac Arrest Due to Cardiac Etiology and Regional Disparity of the Number of Physicians

Circulation ◽

10.1161/circ.138.suppl_2.246 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Tsukasa Yagi ◽

Ken Nagao ◽

Shigemasa Tani ◽

Eizo Tachibana ◽

Nobutaka Chiba ◽

...

Keyword(s):

Public Health ◽

Cardiac Arrest ◽

Neurological Outcome ◽

Multivariable Analysis ◽

Public Health Problem ◽

Regional Disparity ◽

Favorable Neurological Outcome ◽

The Relationship ◽

Background: Cardiac arrest is a major public health issue worldwide. In Japan, the regional disparity of the number of physicians per 100000 population is also a major public health problem. However, it is unknown whether there is the relationship between favorable neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) due to cardiac etiology and this regional disparity. The aim of the present study was to clarify this relationship using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of OHCA. Methods: From the data of the All-Japan Utstein Registry between 2011 and 2015, we included adult patients who had OHCA due to cardiac etiology. 47 prefectures of Japan were divided into quartiles on the basis of the number of physicians in each prefecture, reported by Ministry of Health, Labor and Welfare in Japan. In addition, study patients were divided into four groups based on these quartiles. We compared favorable neurological outcome at 30 days after OHCA in each group, using the multivariable logistic-regression analysis. Results: Four quartile ranges of the number of physicians were set for this study (Figure). Moreover, of the 629,471 OHCA victims between 2011 and 2015, 358,993 met the inclusion criteria. Figure represented favorable neurological outcome at 30 days after OHCA in each quartile. In the multivariable analysis, the adjusted odds ratios for Quartile 2, Quartile 3 and Quartile 4 compared with Quartile 1 for favorable neurological outcome at 30 days after OHCA was 0.971 (95%CI 0.918- 1.027; P=0.307), 1.011 (95%CI 0.956- 1.069; P=0.703) and 0.850 (95%CI 0.809- 0.893; P<0.001), respectively. Conclusion: The regions in which the number of physicians per 100000 population was larger were inferior to the regions in which the number of these was smaller, in terms of neurological benefits in patients with OHCA due to cardiac etiology.

Medically Important Vector Borne Disease Control-Botanical Plant Extract Trials

Research in Pharmacy and Health Sciences ◽

10.32463/rphs.2018.v04i04.20 ◽

2018 ◽

Vol 4 (4) ◽

pp. 513

Author(s):

Rakhshan .

Keyword(s):

Disease Control ◽

Public Health Problem ◽

Vector Borne Disease ◽

Development Of Resistance ◽

Vector Borne ◽

Synthetic Pesticides ◽

High Level ◽

Continuous Use ◽

Chemical Pesticides

Mosquitoes are vectors of many pathogens which causes serious human diseases like Malaria, Filariasis, Japanese encephalitis, Dengue fever, Chikungunya, Yellow fever and Zika virus which constitute a major public health problem globally. Mosquito borne diseases cause high level of economic impact all over the world and result in millions of death every year. They infect around 700,000,000 people annually worldwide and 40,000,000 only in India. The continuous use of synthetic pesticides to control vector mosquitoes has caused physiological resistance, toxic effect on human health, environmental pollution and addition to these, its adverse effects can be observed on non-target organisms. Synthetic chemical pesticides have been proved to be effective, but overall in last 5 decades indiscriminate use of synthetic pesticides against vector borne disease control have originated several ecological issues due to their residual accumulation and development of resistance in target vectors and their chronic effects.

Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study

Critical Care ◽

10.1186/s13054-021-03606-5 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Sivagowry Rasalingam Mørk ◽

Carsten Stengaard ◽

Louise Linde ◽

Jacob Eifer Møller ◽

Lisette Okkels Jensen ◽

...

Keyword(s):

Logistic Regression ◽

Cardiac Arrest ◽

Survival Rate ◽

Neurological Outcome ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Good Neurological Outcome ◽

Factors Associated ◽

National Consensus ◽

Abstract Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors.

Pediatric In-Hospital Cardiac Arrest International Registry (PACHIN): protocol for a prospective international multicenter register of cardiac arrest in children

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02173-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jimena del Castillo ◽

Débora Sanz ◽

Laura Herrera ◽

Jesús López-Herce ◽

Cristina Calvo ◽

...

Keyword(s):

Cardiac Arrest ◽

Public Health Problem ◽

Neurological Status ◽

Social Contexts ◽

Secondary Outcome ◽

International Registry ◽

Neurological Prognosis ◽

Model Database ◽

Hospital Pediatric

Abstract Background and aims Cardiac arrest (CA) in children is a major public health problem. Thanks to advances in cardiopulmonary resuscitation (CPR) guidelines and teaching skills, results in children have improved. However, pediatric CA has a very high mortality. In the treatment of in-hospital CA there are still multiple controversies. The objective of this study is to develop a multicenter and international registry of in-hospital pediatric cardiac arrest including the diversity of management in different clinical and social contexts. Participation in this register will enable the evaluation of the diagnosis of CA, CPR and post-resuscitation care and its influence in survival and neurological prognosis. Methods An intrahospital CA data recording protocol has been designed following the Utstein model. Database is hosted according to European legislation regarding patient data protection. It is drafted in English and Spanish. Invitation to participate has been sent to Spanish, European and Latinamerican hospitals. Variables included, asses hospital characteristics, the resuscitation team, patient’s demographics and background, CPR, post-resuscitation care, mortality, survival and long-term evolution. Survival at hospital discharge will be evaluated as a primary outcome and survival with good neurological status as a secondary outcome, analyzing the different factors involved in them. The study design is prospective, observational registry of a cohort of pediatric CA. Conclusions This study represents the development of a registry of in-hospital CA in childhood. Its development will provide access to CPR data in different hospital settings and will allow the analysis of current controversies in the treatment of pediatric CA and post-resuscitation care. The results may contribute to the development of further international recommendations. Trial register: ClinicalTrials.gov Identifier: NCT04675918. Registered 19 December 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT04675918?cond=pediatric+cardiac+arrest&draw=2&rank=10

Molecular Analyses of TEM Genes and Their Corresponding Penicillinase-Producing Neisseria gonorrhoeae Isolates in Bangkok, Thailand

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05665-11 ◽

2011 ◽

Vol 56 (2) ◽

pp. 916-920 ◽

Cited By ~ 32

Author(s):

Shu-ichi Nakayama ◽

Chanwit Tribuddharat ◽

Sasiprapa Prombhul ◽

Ken Shimuta ◽

Somporn Srifuengfung ◽

...

Keyword(s):

Neisseria Gonorrhoeae ◽

Public Health Problem ◽

Sexual Network ◽

Genetic Event ◽

Content Type ◽

Extended Spectrum ◽

Resistance To Penicillin ◽

High Level ◽

International Awareness

ABSTRACTNeisseria gonorrhoeaeis a major public health problem globally, especially because the bacterium has developed resistance to most antimicrobials introduced for first-line treatment of gonorrhea. In the present study, 96N. gonorrhoeaeisolates with high-level resistance to penicillin from 121 clinical isolates in Thailand were examined to investigate changes related to their plasmid-mediated penicillin resistance and their molecular epidemiological relationships. A β-lactamase (TEM) gene variant,blaTEM-135, that may be a precursor in the transitional stage of a traditionalblaTEM-1gene into an extended-spectrum β-lactamase (ESBL), possibly causing high resistance to all extended-spectrum cephalosporins inN. gonorrhoeae, was identified. Clonal analysis using multilocus sequence typing (MLST) andN. gonorrhoeaemultiantigen sequence typing (NG-MAST) revealed the existence of a sexual network among patients from Japan and Thailand. Molecular analysis of theblaTEM-135gene showed that the emergence of this allele might not be a rare genetic event and that the allele has evolved in different plasmid backgrounds, which results possibly indicate that it is selected due to antimicrobial pressure. The presence of theblaTEM-135allele in the penicillinase-producingN. gonorrhoeaepopulation may call for monitoring for the possible emergence of ESBL-producingN. gonorrhoeaein the future. This study identified ablaTEMvariant (blaTEM-135) that is a possible intermediate precursor for an ESBL, which warrants international awareness.

Abstract 038: American Heart Association Mission: Lifeline Breakthrough Series Collaborative Improving the Survival Rates for Out of Hospital Cardiac Arrest by Focusing on Early CPR With an Emphasis on Chest Compressions

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.038 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Charles R Siegel ◽

Anjan Chakrabarti ◽

Lewis Siegel ◽

Forrest Winslow ◽

Thomas Hall

Keyword(s):

Cardiac Arrest ◽

Quality Improvement ◽

Performance Measures ◽

Effective Diffusion ◽

Survival Rates ◽

Public Health Problem ◽

Heart Association ◽

Performance Measure ◽

Compression Rate ◽

Introduction: Out-of-hospital cardiac arrest (OHCA) remains a highly morbid public health problem. Despite improving practices and clear guidelines, mortality from this condition remains high at 90%, with survivors often suffering from poor neurologic outcomes. To determine the feasibility of quality improvement collaboratives to narrow gaps between evidence-based practice and patient care for OHCA, we conducted a pilot study of the AHA Resuscitation Collaborative. Methods: Eight emergency medical service agencies participated in the quality improvement collaborative pilot project. We identified several OHCA performance measures to assess the quality of care, guide collaborative activities, and monitor change in performance over time. Over the course of four learning sessions, participants were trained in quality improvement and performance measurement, analyzed performance measure results, and shared successes and challenges. Results: Five remaining agencies underwent the process outlined in Figure 1. Adherence to performance measures, including compression rate compliance (Figure 2), improved over the course of the collaborative. Compression rate compliance in Figure 2 corresponds to the process improvement efforts of the Chesapeake Fire Department with achievement of goals for optimal range of chest compression rate between 100 and 120 compressions per minute during resuscitations. Conclusion: As demonstrated in Virginia, the collaborative approach was an effective framework to improve OHCA care. Improvement in performance measures, the evident commitment of dedicated peers and colleagues, consistent collaboration, and the effective diffusion of best practices all support the continued use of this model.

TCT-23 Contemporary Trends in Utilization of Mechanical Circulatory Support in Patients Hospitalized After Out-of-Hospital Cardiac Arrest

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.09.899 ◽

2016 ◽

Vol 68 (18) ◽

pp. B10

Author(s):

Nileshkumar Patel ◽

Nish Patel ◽

Gabriel Hernandez ◽

Shilpkumar Arora ◽

Apurva Badheka ◽

...

Keyword(s):

Cardiac Arrest ◽

Mechanical Circulatory Support ◽

Circulatory Support ◽

Enhancing the natural toxicity of Salmonella Typhimurium towards tumours

Access Microbiology ◽

10.1099/acmi.ac2020.po0265 ◽

2020 ◽

Vol 2 (7A) ◽

Author(s):

Najla Alfaqeer ◽

Donal Wall

Keyword(s):

Food Poisoning ◽

Public Health Problem ◽

Effector Proteins ◽

Wild Type ◽

Level Of Invasion ◽

Mutant Strains ◽

High Level ◽

Initial Results ◽

Number Of Bacteria

Background and objective: Salmonella is the underlying cause of foodborne diseases and poses a major public health problem worldwide. Research has developed a method to efficiently treat cancer using some of the same bacteria behind food poisoning, one of these bacteria is Salmonella which targets and penetrats tumours specifically by being attracted to the compounds produced by tumour cells and accumulating at the tumour site and inducing inflammation. In this project we aim to investigate the mechanism of Salmonella Typhimurium which has a tremendous ability to invade, replicate and compete to survive inside the cells by virtue of effector proteins such as: sipA, sipB, and AvrA which it possesses. Method: The S.Typhimurium strains used are wild-type SL1344 ( ΔsipA, ΔsipB, ΔavrA and VV341) and attenuated strain of SL7207. Bacteria were cultured in LB broth in a 37 °C shaker overnight to reach a stationary phase before using it to infect B16F10 (mouse melanoma). Results: The initial results show that the infection of B16F10 with wild-type SL1344 had a high level of invasion compared to the low number of bacteria with the deletion of sipB which impaired its entry into the cell. Similarly, the mutant strains ΔsipA and ΔavrA show an increasing number of intracellular bacteria, like the wild-type strain. We will be investigating further on the innate mechanisms of Salmonella in disrupting tumour growth and progression, that might help maximize the potential of using these bacteria in monotherapy or in tandem with other useful therapies.

Contemporary Management of Out-of-hospital Cardiac Arrest in the Cardiac Catheterisation Laboratory: Current Status and Future Directions

Interventional Cardiology Review ◽

10.15420/icr.2019.3.2 ◽

2019 ◽

Vol 14 (3) ◽

pp. 113-123 ◽

Cited By ~ 2

Author(s):

Nilesh Pareek ◽

Peter Kordis ◽

Ian Webb ◽

Marko Noc ◽

Philip MacCarthy ◽

...

Keyword(s):

Cardiac Arrest ◽

Coronary Angiography ◽

Mechanical Circulatory Support ◽

Developed Countries ◽

Cardiac Catheterisation ◽

Temperature Management ◽

Current Status ◽

Circulatory Support ◽

Hospital Cardiac Arrest ◽

Catheterisation Laboratory

Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and morbidity in developed countries and remains an important public health burden. A primary cardiac aetiology is common in OHCA patients, and so patients are increasingly brought to specialist cardiac centres for consideration of coronary angiography, percutaneous coronary intervention and mechanical circulatory support. This article focuses on the management of OHCA in the cardiac catheterisation laboratory. In particular, it addresses conveyance of the OHCA patient direct to a specialist centre, the role of targeted temperature management, pharmacological considerations, provision of early coronary angiography and mechanical circulatory support.