Abstract 331: Argon Promotes Vasorelaxation in Rat Pulmonary and Mesenteric Arteries

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Elaine L Shelton ◽  
Courtney D Berger ◽  
Michele M Salzman ◽  
Claudius Balzer ◽  
Matthias L Riess
Keyword(s):  
Cardiac Arrest ◽  
Noble Gas ◽  
Ischemia Reperfusion ◽  
Pulmonary Arteries ◽  
Volatile Anesthetic ◽  
Mesenteric Arteries ◽  
Luminal Diameter ◽  
Potential Harm ◽  
The Us ◽  
Hospital Cardiac Arrest

Introduction: Despite cardiopulmonary resuscitation (CPR), more than 90% of patients having an out-of-hospital cardiac arrest in the US still die or endure severe neurological damage due to ischemia/reperfusion (IR) injury. Ventilation with Argon during CPR improves oxygenation, cardiac output, and survival in a porcine model of cardiac arrest. Similarly, inhalation of the volatile anesthetic, Sevoflurane, during CPR improves hemodynamic outcomes, but its usefulness is limited by its anesthetic effect and potential harm to providers and bystanders. In contrast, non-anesthetic noble gases like Argon can be safely administered outside of the hospital and may serve as a feasible adjuvant to mitigate IR injury following cardiac arrest. We hypothesize that Argon can decrease pulmonary and/or systemic vascular resistance, which may improve hemodynamic outcomes. Methods: Pressure myography assays were performed on isolated rat pulmonary and mesenteric arteries to determine the ability of Argon to promote vasodilation. Vessels were mounted in microvessel perfusion chambers and challenged with oxygenated Krebs buffer balanced with Argon (65%Argon:30%O 2 :5%CO 2 ) or Nitrogen (65%N 2 :30%O 2 :5%CO 2 ). Changes in intra-luminal diameter were recorded. Statistics: one-way ANOVA, p< 0.05. Results: Pulmonary arteries dilated in response to O 2 , while mesenteric arteries constricted. Argon exposure made pulmonary vessels significantly more sensitive to O 2 -induced dilation (mean Argon dilation = 133%, mean N 2 dilation = 99%). Conversely, argon blunted the ability of O 2 to constrict mesenteric arteries (argon mean constriction = 35%, nitrogen mean constriction = 41%). Conclusion: Our results indicate that Argon has vasodilatory effects in both the pulmonary and systemic circulations, making it a potentially useful therapeutic tool for mitigating IR injury following cardiac arrest or other instances of prolonged hypoperfusion. Future studies will address the mechanism underlying the ability of an inert noble gas to affect vasoactive signaling pathways.

Abstract 25: Cost-Effectiveness of Public Automated External Defibrillators

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Lars W Andersen ◽  
Mathias J Holmberg ◽  
Asger Granfeldt ◽  
Lyndon P James ◽  
Lisa Caulley
Keyword(s):  
Public Health ◽  
Cardiac Arrest ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Automated External Defibrillators ◽  
The Us ◽  
Hospital Cardiac Arrest

Introduction: Despite a consistent association with improved outcomes, automated external defibrillators (AEDs) are used in only approximately 10% of public out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost. The objective of this study was to provide a contemporary cost-effectiveness analysis on the use of public AEDs in the United States (US) to inform guidelines and public health initiatives. Methods: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the US over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs (in 2017 US dollars) per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. It was assumed that AED use was associated with a 52% relative increase in survival to hospital discharge with a favorable neurological outcome in those with a shockable rhythm. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. Consistent with recent guidelines from the American Heart Association, we used a willingness-to-pay threshold of $150,000 per QALY gained. Results: The no AED strategy resulted in 1.63 QALYs at a cost of $42,757. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. At an incidence of 1%, the incremental cost-effectiveness ratio was $101,040 per QALY gained. In sensitivity analyses across a plausible range of health-care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. Conclusion: Public AEDs are a cost-effective public health intervention in the US. These findings support widespread dissemination of public AEDs.

Cerebral Circulation and Cerebral Blood Flow

2019 ◽  
pp. 79-85
Author(s):  
Arnoley S. Abcejo ◽  
Jeffrey J. Pasternak
Keyword(s):  
Blood Flow ◽  
Cardiac Arrest ◽  
Cerebral Blood Flow ◽  
Brain Injury ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
Neurologic Outcomes ◽  
The Us ◽  
Hospital Cardiac Arrest ◽  
Premonitory Symptoms

Cardiac arrest occurs suddenly, often without premonitory symptoms. Consciousness is lost within seconds to minutes because of insufficient cerebral blood flow in the midst of complete hemodynamic collapse. Anoxic-ischemic brain injury is most commonly caused by cardiac arrest, which is frequently lethal; of the US patients with out-of-hospital cardiac arrest treated by emergency medical services, almost 90% die. Among the patients who survive to hospital admission, inpatient mortality may be decreasing, but a substantial number of those survivors have poor neurologic outcomes from anoxic-ischemic brain injury.

scholarly journals Elevated Plasma Soluble PD-L1 Levels in Out-of-Hospital Cardiac Arrest Patients

2021 ◽  
Vol 10 (18) ◽  
pp. 4188
Author(s):  
Miho Sumiyoshi ◽  
Eiji Kawamoto ◽  
Yuki Nakamori ◽  
Ryo Esumi ◽  
Kaoru Ikejiri ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ischemia Reperfusion ◽  
Plasma Concentrations ◽  
Spontaneous Circulation ◽  
University Hospital ◽  
Soluble Form ◽  
Enzyme Linked Immunosorbent Assay ◽  
Immune Functions ◽  
Protein Levels ◽  
Hospital Cardiac Arrest

Background: A deregulated immune system has been implicated in the pathogenesis of post-cardiac arrest syndrome (PCAS). A soluble form of programmed cell death-1 (PD-1) ligand (sPD-L1) has been found at increased levels in cancer and sustained inflammation, thereby deregulating immune functions. Here, we aim to study the possible involvement of sPD-L1 in PCAS. Methods: Thirty out-of-hospital cardiac arrest (OHCA) patients consecutively admitted to the ER of Mie University Hospital were prospectively enrolled. Plasma concentrations of sPD-L1 were measured by an enzyme-linked immunosorbent assay in blood samples of all 30 OHCA patients obtained during cardiopulmonary resuscitation (CPR). In 13 patients who achieved return-of-spontaneous-circulation (ROSC), sPD-L1 levels were also measured daily in the ICU. Results: The plasma concentrations of sPD-L1 in OHCA were significantly increased; in fact, to levels as high as those observed in sepsis. sPD-L1 levels during CPR correlated with reduced peripheral lymphocyte counts and increased C-reactive protein levels. Of 13 ROSC patients, 7 cases survived in the ICU for more than 4 days. A longitudinal analysis of sPD-L1 levels in the 7 ROSC cases revealed that sPD-L1 levels occurred in parallel with organ failure. Conclusions: This study suggests that ischemia- reperfusion during CPR may aberrantly activate immune and endothelial cells to release sPD-L1 into circulation, which may play a role in the pathogenesis of immune exhaustion and organ failures associated with PCAS.

scholarly journals Cyclosporine A prevents ischemia-reperfusion-induced lymphopenia after out-of-hospital cardiac arrest: A predefined sub-study of the CYRUS trial

Resuscitation ◽  
2019 ◽  
Vol 138 ◽  
pp. 129-131 ◽  
Author(s):  
Martin Cour ◽  
Vincent Jahandiez ◽  
Thomas Bochaton ◽  
Fabienne Venet ◽  
Michel Ovize ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cyclosporine A ◽  
Ischemia Reperfusion ◽  
Hospital Cardiac Arrest

Abstract 333: A Prospective Study of the Incidence of Intracranial Hemorrhage in Survivors of Out of Hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Jonathan Gelber ◽  
Martha E Montgomery ◽  
Amandeep Singh
Keyword(s):  
Cardiac Arrest ◽  
Hospital Admission ◽  
Prospective Study ◽  
Intracranial Hemorrhage ◽  
Spontaneous Circulation ◽  
Neurologic Outcome ◽  
The Us ◽  
Good Neurologic Outcome ◽  
A Prospective Study ◽  
Hospital Cardiac Arrest

Introduction: Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence. A single Japanese prospective study found a high incidence of ICH in survivors of OHCA (18.3% incidence), but that data is not generalizable to the US, which has a far lower overall rate of ICH. Aim: This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC). Methods: We prospectively analyzed all consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period from 2018-2020. A standardized order set, including non-contrast head computed-tomography (NCH-CT), was recommended as part of the initial management for all patients with ROSC after OHCA. Patient and cardiac arrest variables were recorded, as were NCH-CT findings. Results: During the study period, 194 patients presents to the emergency department with OHCA, and 95 patients achieved ROSC and survived to hospital admission. A NCH-CT was obtained in 85/95 patients (89.5%). Twenty-four of 85 patients (28.2%) survived to hospital discharge. Three of 85 patients with NCH-CT had ICH (3.5%). Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH were significantly older than patients without ICH (86.7 years versus 64.4 years, p=0.01). Conclusions: In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission. The incidence of ICH in survivors of OHCA was 3.5%, lower than previously reported retrospective data in the US, and much lower than reported in a prospective Japanese study. No patients with ICH survived with good neurologic outcome.

Abstract 235: The Covid-19 Pandemic in Dallas: Increased Out-of-hospital Cardiac Arrest and Death

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Lin Guo ◽  
Pamela Owens ◽  
Marshal Isaacs ◽  
Tami Kayea ◽  
Lu Ann McKee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Cardiovascular Events ◽  
Fort Worth ◽  
Excess Death ◽  
The Us ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest ◽  
Excess Deaths

Introduction: Since March, the CDC has reported weekly excess deaths of up to 40% in the US. Spikes in excess deaths were associated with spikes in COVID-19 cases. In Texas, 55% of excess deaths from March 1 to May 30, 2020 were unattributed to COVID-19. One possible source of this unaccounted excess death is out-of-hospital cardiac arrest, which corresponds to a notable decline in hospitalizations for acute cardiovascular events. Objective: To compare the number of out-of-hospital cardiac arrest (OOHCA) and dead-on-scene cases in Dallas, Texas in years prior to and during the COVID-19 pandemic. Methods: The Dallas-Fort Worth Center for Resuscitation Research Cardiac Arrest Registry provided data for this IRB-approved study. Eligible cases were non-traumatic OOHCAs who received cardiopulmonary resuscitation (CPR) from emergency medical services (EMS) providers. We compared monthly case numbers in 2017, 2018, and 2019 with case numbers in 2020 at the time of the COVID-19 pandemic in Dallas, TX. Additionally, we compared the numbers of non-traumatic deaths (declared dead on scene without receiving CPR from EMS providers) in the same timeframes. Results: While total counts of out-of-hospital cardiac arrest during the months of March to June decreased from 2017 to 2019 by 9.2% and 1.2% respectively, the number of cardiac arrest cases rose dramatically by 47.9% in 2020 (p < 0.05).(Table) The percentage of OOHCAs with an initial rhythm of asystole increased as well, from 50.1% in 2018 and 2019 to 60.4% in 2020. The total number of dead-on-scene cases was also higher in March to June 2020 than in 2017 to 2019 (NS). Conclusion: Increased out-of-hospital cardiac arrest is likely contributing to the unattributed excess deaths noted during the months of the COVID-19 pandemic in Dallas, TX. The rise in cases may be indirectly attributable to COVID-19 as cardiovascular events go untreated or treated too late.

scholarly journals Catalase Predicts In-Hospital Mortality after Out-of-Hospital Cardiac Arrest

2021 ◽  
Vol 10 (17) ◽  
pp. 3906
Author(s):  
Anton Früh ◽  
Andrea Bileck ◽  
Besnik Muqaku ◽  
Raphael Wurm ◽  
Benjamin Neuditschko ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Plasma Levels ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
High Plasma ◽  
Spontaneous Circulation ◽  
Multiple Organ ◽  
Kaplan Meier ◽  
Median Plasma ◽  
Hospital Cardiac Arrest

The generation of harmful reactive oxygen species (ROS), including hydrogen peroxide, in out-of-hospital cardiac arrest (OHCA) survivors causes systemic ischemia/reperfusion injury that may lead to multiple organ dysfunction and mortality. We hypothesized that the antioxidant enzyme catalase may attenuate these pathophysiological processes after cardiac arrest. Therefore, we aimed to analyze the predictive value of catalase levels for mortality in OHCA survivors. In a prospective, single-center study, catalase levels were determined in OHCA survivors 48 h after the return of spontaneous circulation. Thirty-day mortality was defined as the study end point. A total of 96 OHCA survivors were enrolled, of whom 26% (n = 25) died within the first 30 days after OHCA. The median plasma intensity levels (log2) of catalase were 8.25 (IQR 7.64–8.81). Plasma levels of catalase were found to be associated with mortality, with an adjusted HR of 2.13 (95% CI 1.07–4.23, p = 0.032). A Kaplan–Meier analysis showed a significant increase in 30-day mortality in patients with high catalase plasma levels compared to patients with low catalase levels (p = 0.012). High plasma levels of catalase are a strong and independent predictor for 30-day mortality in OHCA survivors. This indicates that ROS-dependent tissue damage is playing a crucial role in fatal outcomes of post-cardiac syndrome patients.

Non-Occlusive Mesenteric Ischemia After Resuscitative Endovascular Balloon Occlusion of the Aorta for Out-of-Hospital Cardiac Arrest due to Massive Gastrointestinal Bleeding

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Shinsuke Tanizaki ◽  
Takeo Matsumoto ◽  
Misaki Murasaki ◽  
Minoru Hayashi ◽  
Shigenobu Maeda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mesenteric Ischemia ◽  
Life Support ◽  
Ischemia Reperfusion ◽  
Balloon Occlusion ◽  
Low Flow ◽  
Massive Gastrointestinal Bleeding ◽  
Occlusive Mesenteric Ischemia ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a method of controlling intra-abdominal bleeding in case of hemorrhagic shock and an adjunct to improve traditional advanced cardiac life support in nontraumatic cardiac arrest. Partial REBOA is proposed as an alternative method that regulates low volume continuous blood flow across the area of occlusion with the aim of minimizing ischemia-reperfusion injury. Case Presentation: An 82-year-old male suffered an out-of-hospital cardiac arrest due to massive gastric bleeding. He was initially resuscitated with partial REBOA but died of non-occlusive mesenteric ischemia (NOMI). The possible causes of NOMI were the patient’s age, the low flow state with prolonged cardiopulmonary resuscitation, the lower proximal-to-distal gradient of partial REBOA, and the longer time of total occlusion. Conclusion: Further studies may be required to determine the optimal distal pressure during partial REBOA to limit the burden of mesenteric ischemia.

scholarly journals Non-Occlusive Mesenteric Ischemia After Resuscitative Endovascular Balloon Occlusion of the Aorta for Out-of-Hospital Cardiac Arrest due to Massive Gastrointestinal Bleeding

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Shinsuke Tanizaki ◽  
Takeo Matsumoto ◽  
Misaki Murasaki ◽  
Minoru Hayashi ◽  
Shigenobu Maeda ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mesenteric Ischemia ◽  
Life Support ◽  
Ischemia Reperfusion ◽  
Balloon Occlusion ◽  
Low Flow ◽  
Massive Gastrointestinal Bleeding ◽  
Occlusive Mesenteric Ischemia ◽  
Hospital Cardiac Arrest ◽  
Endovascular Balloon Occlusion

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used as a method of controlling intra-abdominal bleeding in case of hemorrhagic shock and an adjunct to improve traditional advanced cardiac life support in nontraumatic cardiac arrest. Partial REBOA is proposed as an alternative method that regulates low volume continuous blood flow across the area of occlusion with the aim of minimizing ischemia-reperfusion injury. Case Presentation: An 82-year-old male suffered an out-of-hospital cardiac arrest due to massive gastric bleeding. He was initially resuscitated with partial REBOA but died of non-occlusive mesenteric ischemia (NOMI). The possible causes of NOMI were the patient’s age, the low flow state with prolonged cardiopulmonary resuscitation, the lower proximal-to-distal gradient of partial REBOA, and the longer time of total occlusion. Conclusion: Further studies may be required to determine the optimal distal pressure during partial REBOA to limit the burden of mesenteric ischemia.

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