scholarly journals Features of high flow access in the elderly

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 71-75
Author(s):  
Taro Kanno ◽  
Yutaka Kanno ◽  
Kazunari Shiroi ◽  
Nobuhiko Kobayashi ◽  
Natsumi Matsushita ◽  
...  
Keyword(s):  
Blood Flow ◽  
Elderly Patients ◽  
Young Patients ◽  
The Elderly ◽  
High Flow ◽  
Low Flow ◽  
Flow Volume ◽  
Middle Aged ◽  
Run Off ◽  
Elderly Hemodialysis Patients

Introduction: The number of elderly hemodialysis patients continues to grow. The aim of this study was to investigate differences in elderly high flow access patients compared with middle-aged and young patients. Methods: We performed a retrospective study to determine the characteristics of elderly patients (aged >60 years) following blood flow suppression procedures. Preoperative and postoperative data from 177 patients who underwent blood flow suppression procedures and 73 patients who underwent procedures for run-off vein ligation and subcutaneous fixation of the superficial artery were compared. Results: A high proportion of young (aged 20–40 years) and middle-aged (aged 41–60 years) patients met the criteria for blood flow suppression procedures (flow volume 1500 mL/min, flow volume/cardiac output 35%), whereas a high proportion of elderly patients did not. Moreover, heart strain could evidently be caused even with low flow volume. In elderly patients, a tricuspid regurgitation pressure gradient and right heart strain were observed more frequently. Conclusion: Elderly patients who underwent blood flow suppression procedures or subcutaneous fixation of the superficial artery exhibited lower flow volume, and the effects of high flow access in elderly patients depend on the nature of vascular changes. Ultimately, the underlying conditions and hemodynamics of each patient must be determined on an individual basis.

scholarly journals Increased plasma angiotensin II in postural tachycardia syndrome (POTS) is related to reduced blood flow and blood volume

2006 ◽  
Vol 110 (2) ◽  
pp. 255-263 ◽  
Author(s):  
Julian M. Stewart ◽  
June L. Glover ◽  
Marvin S. Medow
Keyword(s):  
Blood Flow ◽  
Angiotensin Ii ◽  
Blood Volume ◽  
High Flow ◽  
The Other ◽  
Low Flow ◽  
Postural Tachycardia Syndrome ◽  
Peripheral Blood Flow ◽  
Ang Ii ◽  
Postural Tachycardia

POTS (postural tachycardia syndrome) is associated with low blood volume and reduced renin and aldosterone; however, the role of Ang (angiotensin) II has not been investigated. Previous studies have suggested that a subset of POTS patients with increased vasoconstriction related to decreased bioavailable NO (nitric oxide) have decreased blood volume. Ang II reduces bioavailable NO and is integral to the renin–Ang system. Thus, in the present study, we investigated the relationship between blood volume, Ang II, renin, aldosterone and peripheral blood flow in POTS patients. POTS was diagnosed by 70° upright tilt, and supine calf blood flow, measured by venous occlusion plethysmography, was used to subgroup POTS patients. A total of 23 POTS patients were partitioned; ten with low blood flow, eight with normal flow and five with high flow. There were ten healthy volunteers. Blood volume was measured by dye dilution. All biochemical measurements were performed whilst supine. Blood volume was decreased in low-flow POTS (2.14±0.12 litres/m2) compared with controls (2.76±0.20 litres/m2), but not in the other subgroups. PRA (plasma renin activity) was decreased in low-flow POTS compared with controls (0.49±0.12 compared with 0.90±0.18 ng of Ang I·ml−1·h−1 respectively), whereas plasma Ang II was increased (89±20 compared with 32±4 ng/l), but not in the other subgroups. PRA correlated with aldosterone (r=+0.71) in all subjects. PRA correlated negatively with blood volume (r=−0.72) in normal- and high-flow POTS, but positively (r=+0.65) in low-flow POTS. PRA correlated positively with Ang II (r=+0.76) in normal- and high-flow POTS, but negatively (r=−0.83) in low-flow POTS. Blood volume was negatively correlated with Ang II (r=−0.66) in normal- and high-flow POTS and in five low-flow POTS patients. The remaining five low-flow POTS patients had reduced blood volume and increased Ang II which was not correlated with blood volume. The data suggest that plasma Ang II is increased in low-flow POTS patients with hypovolaemia, which may contribute to local blood flow dysregulation and reduced NO bioavailability.

scholarly journals Cisplatin-induced renal toxicity in elderly people

2020 ◽  
Vol 12 ◽  
pp. 175883592092343 ◽  
Author(s):  
ZhiYu Duan ◽  
GuangYan Cai ◽  
JiJun Li ◽  
XiangMei Chen
Keyword(s):  
Elderly Patients ◽  
Elderly People ◽  
Renal Toxicity ◽  
Enzyme Inhibitor ◽  
Interstitial Fibrosis ◽  
Angiotensin Receptor Blockers ◽  
Young Patients ◽  
Kidney Injury ◽  
The Elderly ◽  
Tubular Atrophy

Despite available prevention and treatment measures, such as hydration, diuresis, magnesium supplementation, and amifostine, renal toxicity is still one of the major dose-limiting side effects of cisplatin. The aim of this review is to discuss the issue of cisplatin-induced nephrotoxicity in the elderly. Compared with young patients, the incidences of cisplatin-induced nephrotoxicity and acute kidney injury (AKI) in elderly patients are significantly increased, and survival time may be decreased. Following cisplatin treatment of elderly patients, tubulointerstitial injuries will be significantly aggravated based on their original age, both for acute injuries due to cell necrosis and exfoliation and chronic injuries due to interstitial fibrosis, tubular atrophy, and dilatation. The high incidence of cisplatin-induced nephrotoxicity in elderly patients may be associated with renal hypoperfusion; increased comorbidities, such as chronic kidney disease (CKD), cardiovascular disease, and diabetes mellitus; increased use of combined drugs [especially non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor and angiotensin receptor blockers (ACEI/ARB), and antibiotics]; decreased clearance of cisplatin; and high plasma ultrafilterable cisplatin. Considering hemodynamic stability and water balance, short duration and low volume hydration may be more suitable for treating elderly people. With the increasing popularity of low-dose daily/weekly regimens, we do not recommend routine diuretic treatment for elderly patients. We recommend using a less nephrotoxic platinum if large doses of cisplatin (100mg/m2) are needed.

The Effect of Altered Cerebral Blood Flow on the Cerebral Kinetics of Thiopental and Propofol in Sheep

2000 ◽  
Vol 93 (4) ◽  
pp. 1085-1094 ◽  
Author(s):  
Richard N. Upton ◽  
Guy L. Ludbrook ◽  
Cliff Grant ◽  
David J. Doolette
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Random Order ◽  
High Flow ◽  
Low Flow ◽  
Flow State ◽  
Concentration Difference ◽  
Blood Flows ◽  
Kinetics Of ◽  
The Brain

Background Thiopental and propofol are highly lipid-soluble, and their entry into the brain often is assumed to be limited by cerebral blood flow rather than by a diffusion barrier. However, there is little direct experimental evidence for this assumption. Methods The cerebral kinetics of thiopental and propofol were examined over a range of cerebral blood flows using five and six chronically instrumented sheep, respectively. Using anesthesia (2.0% halothane), three steady state levels of cerebral blood flow (low, medium, and high) were achieved in random order by altering arterial carbon dioxide tension. For each flow state, 250 mg thiopental or 100 mg propofol was infused intravenously over 2 min. To quantify cerebral kinetics, arterial and sagittal sinus blood was sampled rapidly for 20 min from the start of the infusion, and 1.5 h was allowed between consecutive infusions. Various models of cerebral kinetics were examined for their ability to account for the data. Results The mean baseline cerebral blood flows for the "high" flow state were over threefold greater than those for the low. For the high-flow state the normalized arteriovenous concentration difference across the brain was smaller than for the low-flow state, for both drugs. The data were better described by a model with partial membrane limitation than those with only flow limitation or dispersion. Conclusions The cerebral kinetics of thiopental and propofol after bolus injection were dependent on cerebral blood flow, despite partial diffusion limitation. Higher flows produce higher peak cerebral concentrations.

scholarly journals Remodeling of Resistance Arteries in Renal Failure: Effect of Endothelin Receptor Blockade

2001 ◽  
Vol 12 (10) ◽  
pp. 2040-2050 ◽  
Author(s):  
KERSTIN AMANN ◽  
GABRIEL MIL TENBERGER-MIL TENYI ◽  
AURELIA SIMONOVICIENE ◽  
ANDREAS KOCH ◽  
STEPHAN ORTH ◽  
...  
Keyword(s):  
Renal Failure ◽  
Blood Flow ◽  
High Flow ◽  
Mesenteric Arteries ◽  
Low Flow ◽  
Normal Flow ◽  
Flow Conditions ◽  
First Order ◽  
The Media ◽  
Intimal Thickness

Abstract. Remodeling of vessels is a known feature of renal failure, but it is unclear whether this represents an appropriate or inappropriate response to the known changes in blood flow, shear stress, and wall tension. To investigate remodeling in response to variations in blood flow, first-order mesenteric arteries were exposed to high- and low-flow conditions via the ligation of second-order branches, according to the technique described by Pour-ageaud and De Mey. The resulting changes in vessel geometric features, relative proportions of intima and media, submicroscopic structure, and immunostaining for proliferating cell nuclear antigen (PCNA), endothelin-1 (ET-1), and ETAreceptors were assessed in first-order mesenteric arteries under low-flow and high-flow conditions. Subtotally nephrectomized (SNX) animals were compared with sham-operated rats. Animals either were left untreated or were treated with the ETAreceptor antagonist (ET-RA) LU-135252, because of suggestions in the literature that ET is involved in vascular remodeling in uremia. A highly significant increase in intimal thickness was noted in low-flow arteries (4.21 ± 1.39 μm) of SNX animals, compared with normal-flow arteries (2.06 ± 0.61 μm), but this increase was not observed in sham-operated rats (1.38 ± 0.77 in low-flow arteriesversus2.40 ± 0.35 μm in normal-flow arteries). The increase in intimal thickness in low-flow arteries was abrogated by ET-RA. The medial thickness was increased in untreated SNX animals (19.5 ± 3.61 μm), compared with sham-operated rats, and this increase was also prevented by ET-RA. The medial thickness was not affected by low flow in either sham-operated or SNX animals. In parallel, the number of PCNA-positive intimal cells was higher in low-flow, but not high-flow, arteries of SNX rats, compared with sham-operated rats. No significant change was observed in sham-operated animals. In the media, the number of PCNA-positive cells was higher in untreated SNX animals than in sham-operated rats. The number was even more markedly increased in high-flow, but not low-flow, vessels. This increase was abrogated by ET-RA. It is concluded that, in uremic animals, the response of the intima to low flow and the response of the media to high flow are exaggerated. Both responses are apparently mediated by ET.

scholarly journals Differences in Preoperative Gastric Ultrasound Findings Between Old and Young Surgical Patients: A Retrospective Case-Control Study

2021 ◽  
Author(s):  
Jin Hee Ahn ◽  
Jae-Geum Shim ◽  
Sung Hyun Lee ◽  
Kyoung-Ho Ryu ◽  
Mi Yeon Lee ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Case Control Study ◽  
Young Patients ◽  
The Elderly ◽  
Young Group ◽  
Pulmonary Aspiration ◽  
Elderly Group ◽  
Retrospective Case ◽  
Cutoff Values ◽  
Control Study

Abstract Background: Most gastric ultrasound studies have been conducted in young middle-aged patients. Although age is known to influence gastric ultrasound, comparisons of gastric ultrasound in elderly patients with young patients have not been well elucidated. This study aimed to 1) compare gastric ultrasound assessments between young and elderly patients, 2) determine whether the CSA cutoff values for elderly and young patients should be different, and 3) suggest CSA cutoff values for elderly patients.Methods: This retrospective case-control study evaluated the data of 120 patients who underwent elective surgery under general anesthesia between July 2019 and August 2020. Demographic and gastric ultrasound assessment data were retrieved. Patients were divided into the elderly group (n = 58, age: ≥65 years) and young group (n = 62, age: <65 years). The antral cross-sectional area (CSA) in the supine and right lateral decubitus positions (RLDP), semiquantitative three-point Perlas grade (grades 0, 1, and 2), and gastric volume were determined. CSAs according to different Perlas grades were compared between the two groups. The CSA cutoff values for predicting a high risk of pulmonary aspiration in both the groups were determined. Results: Among patients with Perlas grade 0 (empty stomach), the CSA supine and CSA RLDP were greater in the elderly group than in the young group (CSA supine: 5.12 ± 1.99 cm2 vs. 3.92 ± 0.19 cm2, P = 0.002, and CSA RLDP: 6.24 ± 0.43 cm2 vs. 4.58 ± 0.21 cm2, P = 0.002). The specificity, positive predictive value, and accuracy of the CSA decreased when the CSA cutoff value for the young group (CSA RLDP: 6.92 cm2) was applied to the elderly group. The CSA cutoff values for the elderly group were: CSA supine, 6.92 cm2 and CSA RLDP, 10.65 cm2.Conclusions: The CSA of the empty stomach was greater in elderly patients than in young patients. The CSA cutoff values for predicting pulmonary aspiration risk in elderly and young patients should be differentiated. We suggest that the following CSA cutoff values should be used for predicting pulmonary aspiration risk in elderly patients: CSA supine, 6.92 cm2 and CSA RLDP, 10.65 cm2.

scholarly journals Aging as a Risk Factor on the Immunoexpression of Pro-Inflammatory IL-1β, IL-6 and TNF-α Cytokines in Chronic Apical Periodontitis Lesions

Biology ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 14
Author(s):  
Quésia Euclides Teixeira ◽  
Dennis de Carvalho Ferreira ◽  
Alexandre Marques Paes da Silva ◽  
Lucio Souza Gonçalves ◽  
Fabio Ramoa Pires ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Inflammatory Cytokines ◽  
Inflammatory Responses ◽  
The Elderly ◽  
Apical Periodontitis ◽  
Middle Aged ◽  
Tnf Α ◽  
Significant Difference ◽  
Cytokine Levels ◽  
Pro Inflammatory Cytokines

Persistent inflammatory responses in the elderly may act as modifiers on the progression and repair of chronic apical periodontitis lesions (CAPLs). While the involvement of IL-1β, IL-6 and TNF-α in inflammatory responses and, particularly, in CAPL has been documented, their expression in elderly patients needs to be further characterized. Therefore, the purpose of this study was to evaluate and compare the expressions of pro-inflammatory cytokines in CAPL from elderly individuals with young/middle-aged individuals. Thirty CAPL (15 cysts and 15 granulomas) from elderly patients (>60 years) and 30 CAPL (15 cysts and 15 granuloma) from young/middle-aged individuals (20–56 years) were selected. Immunohistochemical reactions were performed against IL-1β, IL-6 and TNF-α. The slides were subdivided into five high-magnification fields and analyzed. The number of positive stains was evaluated for each antibody. There was no significant difference between the cytokines when the cysts and granuloma were compared in the two groups. In the young/middle-aged, only IL-1β showed a difference and was significantly higher in granulomas (p = 0.019). CAPL pro-inflammatory cytokine levels in the elderly were significantly higher than in young/middle-aged individuals (p < 0.05). The pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were significantly higher in CAPL in the elderly compared with the young/middle-aged group. Further elaborate research studies/analyses to elucidate the reasons for and consequences of inflammation in the elderly are recommended.

Hodgkin’s lymphoma in the elderly veterans: We need to do better

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17554-17554
Author(s):  
M. H. Al Sayyed ◽  
S. F. Maken ◽  
M. M. Safa ◽  
Z. A. Nahleh ◽  
J. R. Pancoast ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hodgkin’S Lymphoma ◽  
Young Patients ◽  
The Elderly ◽  
Hodgkin's Lymphoma ◽  
P Value ◽  
Bulky Disease ◽  
Cancer Data ◽  
Veteran Affairs ◽  
Medical Centers

17554 Background: Recent studies demonstrated worse outcome in elderly patients diagnosed with Hodgkin’s Lymphoma (HL). The purpose of this study was to compare the presenting features, treatment, and outcome of elderly patients with HL within the Veteran Affairs Health care system (VA). Methods: This was a retrospective analysis. The VA Central Cancer Registry (VACCR) database was used to identify patients with HL diagnosed between 1995 and 2005. There are approximately 120 VA medical centers diagnosing and/or treating patients with cancer. Data are entered by tumor registrars at the VA medical centers. This site aggregates the data collected by the medical centers’ cancer registries. Data was extrapolated and analyzed using bio-statistical software SPSS. Results: We analyzed 1009 patients in the Veteran Affairs (VA) database with the diagnosis of Hodgkin’s lymphoma. Patients were divided into two groups according to age, elderly group (> 60 years) (n = 383) and young group (Age ≤ 60 years) (n = 626). The median age of presentation in elderly patients was 70 years; the most common stage at diagnosis was Stage IV. The most common histological subtype was nodular sclerosis and bulky disease was present in 89 (23.2%) of patients. Out of 383 patients 237 (62%) were treated with chemotherapy, 88 patients (23%) received radiation. Compared to patients ≤ 60 years of age, elderly patients were less likely to be current smokers, more likely to be caucasian, all other baseline characteristics were not statistically significantly different. Less elderly patients received chemotherapy compared to young patients (62% versus 74%) (P-value 0.004). No difference was observed in radiation therapy. The 5 year Overall survival in the elderly was 27 % compared to 70% in patients aged 60 or less. (P-value <0.005). Conclusions: Outcome of HL among elderly veterans is poor. Elderly patients received less chemotherapy treatment. Novel strategies to better deliver treatment in elderly patients with HL are warranted. No significant financial relationships to disclose.

A pooled analysis of the effect of age on adjuvant cisplatin-based chemotherapy for completely resected non-small cell lung cancer (NSCLC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7553-7553 ◽  
Author(s):  
M. Fruh ◽  
H. Tribodet ◽  
J. Pignon ◽  
T. Winton ◽  
T. Le Chevalier ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Elderly Patients ◽  
Performance Status ◽  
Age Groups ◽  
Young Patients ◽  
Disease Free Survival ◽  
The Elderly ◽  
Pooled Analysis ◽  
Severe Toxicity ◽  
Cox Models

7553 Background: Adjuvant cisplatin-based chemotherapy (CT) has been shown to increase survival in NSCLC, but uncertainty exists concerning its efficacy and toxicity in elderly patients (≥ 70). Methods: We performed a pooled analysis using individual patient data from 4,584 patients in the LACE database with resected stage IA-III NSCLC enrolled in 5 randomized trials, comparing postoperative CT to no CT (ALPI, ANITA, BLT, IALT and JBR10). Patient and treatment characteristics, CT toxicity and delivery, overall survival, disease-free survival (DFS) and cause-specific mortality were compared among 3 age groups: 3,269 (71%) young (<65), 901 (20%) mid-category (65–69) and 414 (9%) elderly (≥70). The analysis was performed on an intent-to-treat basis. Cox models stratified by trials and adjusted for age, associated drug, planned radiotherapy, total dose of cisplatin (<300, 300, >300), gender, stage, performance status, type of surgery and histology were used with a test for trend to study the effect of CT on survival according to age. Results: Baseline characteristics differed among the age groups, but this was due mainly to the different trial populations and designs. No difference in severe toxicity rate was observed among the age groups. Elderly patients received significantly smaller total doses of cisplatin than the other patients (Chi2-test: p<0.0001) and also the cisplatin doses received were more often lower than the planned one (Kruskal-Wallis test: p<0.0001). The Hazard ratio (HR) of death for the young patients was 0.82 (95% CI 0.73–0.92), 0.86 (95% CI 0.70–1.07) for the mid category and 1.01 (95% CI 0.78–1.32) for elderly patients (test for trend: p=0.17). The HR for DFS was 0.79 (95% CI 0.71–0.87) for the young, 0.76 (95% 0.62–0.93) for the mid category and 0.94 (95% CI 0.73–1.22) for the elderly patients (test for trend: p=0.35). More elderly patients died from non- lung cancer related causes (10% young, 16% mid category and 20% elderly; p<0.0001). Conclusions: The survival benefit from cisplatin-based adjuvant therapy for NSCLC patients was not significantly different according to age, but this may be due to lack of power. Supported by unrestricted grants from PHRC and LNCC No significant financial relationships to disclose.

Features of clinical course of vulva cancer in reproductive patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15519-e15519
Author(s):  
Ekaterina Nerodo ◽  
Galina A. Nerodo
Keyword(s):  
Elderly Patients ◽  
Cancer Patients ◽  
Clinical Course ◽  
Young Patients ◽  
The Elderly ◽  
Reproductive Age ◽  
Free Survival ◽  
Early Stages ◽  
The One ◽  
Vulva Cancer

e15519 Background: The significant increase of vulva cancer patients in young and middle age is observed during the last ten years. Methods: To compare the clinical course of vulva cancer in reproductive patients (under 50 years of age) with the one in elderly agewe performed the comparative analysis of clinical characteristics of 839 vulva cancer patients, aged 20-90, with stages I-IV carcinoma who underwent standard complex antitumour treatment. Results: The reproductive group included 64 patients (7.6%), 775 patients (92.4%) were over 50 years. These included prevailed groups of 61-70 years of age – 38% and 71-80 years of age – 34%. Early stages of the disease were observed in 48% of all cases, st. III-IV – in 52%. In the reproductive group st. I was observed in 18.75%, st. II – 51.56%, st. III – 23.43%, st. IV – 6.25%. 70.03% patients of reproductive age had early stages of the disease, that is significantly higher than in the group of elderly patients: 51-70 years of age – 55%, 71-80 years of age – 40%, more than 80 years of age – only 25%(p<0.05). Age characteristics of vulva cancer patients in reproductive group were the following: 20-30 years of age – 10.9%, 31-40 years of age – 32.8%, 41-50 years of age – 56.25%. Organ-preserving operations carried out according to strict individual indications were performed to 35 sexually active patients in early stages. Relapses of the disease were revealed in 11 patients out of 64 (17%) in the reproductive group, and in 180 out of 775 (23.2%) patients in the elderly group(p<0,05) Relapses occurred in 8% of reproductive patients with st. I of the disease, st. II – 9%, st. III – 46%. Med locoregional free-survival was in st.I-72,3 mon. ,in st. II-61,3 mon., in st III-17,3 mon. All patients with inoperable tumour relapse underwent chemotherapy with subsequent tumour removal. Conclusions: Vulva cancer in patients of reproductive age is revealed in early stages more often that in elderly patients. There is a possibility to perform organ-preserving operations in young patients, which doesn't lead to relapse increase.

Abstract 271: Continuous Amplitude Spectral Area May Reflect Adequacy of Myocardial Perfusion Before Attempting Defibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Raúl J Gazmuri ◽  
Christopher L Kaufman ◽  
Herbert K Whitehouse ◽  
Alvin Baetiong ◽  
Jeejabai Radhakrishnan
Keyword(s):  
Blood Flow ◽  
Myocardial Perfusion ◽  
High Flow ◽  
Low Flow ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Electrical Shock ◽  
Spectral Area ◽  
Electrical Shocks ◽  
Initial Shock

Background: Previous studies have shown that analysis of the VF amplitude-spectral area (AMSA) contains information predictive of electrical shock success. However, the underlying factors that determine AMSA remain elusive. We developed an open-chest swine model of VF in which we modeled “average CPR” followed by “highly effective CPR” using extracorporeal circulation (ECC) and assessed AMSA in relation to adequacy of coronary perfusion. Methods: VF was electrically induced and left untreated for 8 min in 8 pigs after which ECC was started and maintained for 10 min adjusting the flow to generate a coronary perfusion pressure (CPP) of 10 mmHg (low-flow ECC). After delivery of an initial shock, the ECC flow was increased and titrated to secure a mean aortic pressure of 40 mmHg (high-flow ECC) delivering additional electrical shocks at 60 s intervals. Blood flow through the left anterior descending (LAD) artery was reported relative to baseline (LAD rel). AMSA was measured continuously with a 2.1 s timeframe and a Tukey window that moved ahead every 0.5 s, and was averaged every min for this report (Figure). Results: AMSA increased during the initial 5 min of low-flow ECC, but subsequently decreased (Figure). The initial shock uniformly failed to terminate VF prompting increases in ECC to high-flow, which then resulted in the return of spontaneous circulation in each instance after 3 to 5 shocks. During the high-flow ECC, AMSA initially increased but then gradually decreased for reasons that are not clear. Before attempting defibrillation, AMSA was positively correlated with LAD rel (r=0.73, p=0.04). Conclusion: The study provides intriguing data showing changes in AMSA that are time dependent and likely influenced by myocardial perfusion and the effects of electrical shocks on the myocardium. The present study also suggests that the level of AMSA prior to attempting defibrillation may be influenced by the efficacy with which the CPR intervention generates coronary blood flow.

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