Successful treatment of severe electrolyte imbalance-induced cardiac arrest caused by adrenal tuberculosis with ECMO in the ED

Abstract Background Tuberculosis (TB) is a chronic infectious disease, common in China. TB bacteria can invade multiple organs throughout the body, but they rarely cause critical illness. We present a complex critically ill case in this report. Case presentation A 40-year-old man suffered sudden cardiac arrest during an emergency room visit. Spontaneous circulation resumed after emergency cardiopulmonary resuscitation (CPR), but recurrent ventricular fibrillation and refractory cardiac shock emerged. Thereafter, extracorporeal membrane oxygenation (ECMO) was implemented to maintain hemodynamic stability. Blood test results revealed that the patient had severe electrolyte imbalance and adrenal insufficiency. Further imaging examination showed multiple tuberculosis lesions throughout the body, including the lungs, adrenal glands, and lumbar spine. In the end, the patient was successfully moved from the ICU after weaning from ECMO and the ventilator, and then transferred to an infectious disease specialist hospital for standard anti-tuberculosis therapy. Conclusions ECMO has won the opportunity for the diagnosis and treatment of this young patient who suffered from a rare cause of cardiac arrest, and finally achieved a good prognosis.

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Out-of-Hospital Resuscitation: Have We Gone Too Far?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004180 ◽

2006 ◽

Vol 21 (6) ◽

pp. 445-450 ◽

Cited By ~ 4

Author(s):

Corita Grudzen

Keyword(s):

Cardiac Arrest ◽

Prehospital Care ◽

Sudden Cardiac Arrest ◽

Hospital Setting ◽

The United States ◽

Spontaneous Circulation ◽

Emergency Medical ◽

Clinical Scenarios ◽

Life Sustaining Treatment ◽

Future Policy

AbstractAmericans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints.

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Abstract 355: Performance of Inclusion and Exclusion Criteria Based on Prognosis in an Interventional Out-of-Hospital Cardiac Arrest Study

Circulation ◽

10.1161/circ.138.suppl_2.355 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Nick Krehel ◽

Clifton W Callaway ◽

Ankur Doshi ◽

Jonathan Elmer ◽

Francis X Guyette ◽

...

Keyword(s):

Cardiac Arrest ◽

Poor Prognosis ◽

Tertiary Care ◽

Good Prognosis ◽

Spontaneous Circulation ◽

Relative Paucity ◽

Poor Outcomes ◽

Cardiac Arrest Study ◽

Tertiary Care Centers ◽

Hospital Cardiac Arrest

Introduction: Selection of out-of-hospital cardiac arrest (OHCA) patients for inclusion in randomized control trials (RCT) presents a challenge. The goal is to enroll patients with severe injury warranting intervention yet exclude those with extreme irreversible disease. Selection early after return of spontaneous circulation (ROSC) is complicated by a relative paucity of prognostic variables. We examined the accuracy of enrollment criteria in the iNO OHCA study (NCT03079102) in excluding patients likely to have good or poor outcomes within three hours (3h) of ROSC. Methods: OHCA patients arriving to two tertiary care centers in Pittsburgh were screened within 3h of ROSC. We excluded subjects that followed commands (good prognosis expected) and subjects expected to have poor prognosis based on: Full Outline of UnResponsiveness Brainstem (FOUR B) score <2; CPR time >40 min; investigator estimate of >95% mortality; CT evidence of cerebral edema or intracranial hemorrhage; clinical evidence of myoclonic status epilepticus; or traumatic OHCA etiology. We also excluded subjects not within 3h of ROSC. We compared discharge survival and good neurologic outcome based on disposition (location). Results: Over a nine-month period we screened 155 patients with ROSC following OHCA, 20 subjects (13%) were included in the study and 135 (87%) were excluded ( Table ). The odds ratio (OR) of survival if excluded for poor prognosis was 0.03 (95% CI: 0.01 - 0.08) and worsened when >1 criteria were met. Exclusion for good prognosis was associated with improved survival (OR = 67.2 [95% CI: 14.3 - 316.3]). Conclusions: Our criteria reliably exclude OHCA subjects with good or poor prognosis within 3h of ROSC, yielding a study population with intermediate survival which can be applicable to future OHCA trials. Our criteria selected a minority (13%) of OHCA patients likely to benefit from intervention while reserving resources.

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Abstract 246: Therapeutic Hypothermia Mimicking Peptide Administration During Cardiopulmonary Resuscitation Improved Cardiac Arrest Survival in Swine

Circulation ◽

10.1161/circ.142.suppl_4.246 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

Matt Oberdier ◽

Jing Li ◽

Dan Ambinder ◽

Xiangdong Zhu ◽

Sarah Fink ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Venous Blood ◽

Plasma Concentrations ◽

Sudden Cardiac Arrest ◽

The United States ◽

Rapid Onset ◽

Spontaneous Circulation ◽

Control Group ◽

Swine Model

Background: Out-of-hospital sudden cardiac arrest is a leading cause of death in the United States, affecting over 350,000 people per year with an overall survival rate around 10%. CPR, defibrillation, and therapeutic hypothermia are common resuscitation strategies, but hypothermia is difficult to implement timely to achieve survival benefit. A cell-permeable peptide TAT-PHLPP9c has been shown to alter metabolic pathways similar to hypothermia, and decreases the release of two biomarkers, taurine and glutamate, during the high osmotic stress of heart stunning and brain injury in a mouse arrest model. Hypothesis: TAT-PHLPP9c, given during CPR, enhances 24-hour survival in a swine ventricular fibrillation (VF) model. Methods: In 14 (8 controls and 6 treated) sedated, intubated, and mechanically ventilated swine, after 5 min of VF, ACLS with vest CPR and periodic defibrillations was performed. Venous blood samples were collected at baseline, after 2 min of CPR, and at 2 and 30 min after return of spontaneous circulation (ROSC). The animals were survived up to 24 hrs and plasma samples were analyzed for glutamate and taurine in 2 controls and 1 animal given peptide. Results: Three of the control animals had ROSC, but none survived for 24 hrs, while 4 of 6 treated animals achieved neurologically intact survival at 24 hrs (p < 0.02). Compared to baseline, both taurine and glutamate plasma concentrations increased in the control group, but the increase was reduced substantially by the peptide treatment at 30 min after ROSC (Figure). Conclusion: The use of the cooling mimicking peptide TAT-PHLPP9c administered during CPR significantly improved 24-hour survival in this swine model of cardiac arrest. It reduced the increase of cerebral and myocardial metabolic biomarkers, which encourages utilizing a strategy of cell-permeable peptides for intravenous administration for more rapid onset of hypothermia-like salutary effects than are possible with current CPR cooling devices.

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Posteclampsia Sudden Cardiac Arrest (SCA): A Rare Etiology

Case Reports in Obstetrics and Gynecology ◽

10.1155/2020/8862839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Nissar Shaikh ◽

Shoaib Nawaz ◽

Arshad Chanda ◽

Seema Nahid ◽

Muhmmad Zubair ◽

...

Keyword(s):

Cardiac Arrest ◽

Magnesium Sulphate ◽

Serum Magnesium ◽

Sudden Cardiac Arrest ◽

Kidney Injury ◽

Spontaneous Circulation ◽

Cardiac Biomarkers ◽

Morbidly Obese ◽

Neurogenic Pulmonary Edema ◽

Normal Range

Eclampsia is associated with high maternal and fetal morbidity and mortality. The mortality in eclampsia is reported to be secondary to cerebrovascular accidents, neurogenic pulmonary edema, or acute kidney injury leading to cardiac arrest. A rarely reported etiology is sudden cardiac arrest (SCA) immediately after the seizure activity. We report a case of morbidly obese multigravida, complicated into postnatal eclampsia developing postseizure SCA due to apnea. Case. A 35-year-old woman in 38 weeks of gestation presented to the women’s hospital emergency with hypertension and proteinuria and had lower section caesarean section under epidural anesthesia and required labetalol infusion. She developed convulsions in the 1st postoperative day, and she was started on magnesium sulphate therapy. After a few minutes, the patient had a 2nd episode of convulsions, apnea, cyanosis, and cardiac asystole requiring cardiopulmonary resuscitation and spontaneous circulation returned in 3 minutes. Her endotracheal intubation was difficult, but we succeeded in the 2nd attempt. She was sedated, ventilated, and required noradrenaline to maintain hemodynamics. Her ECG, echocardiogram, cardiac biomarkers, CT chest/brain, and serum magnesium levels were within normal range. The patient was weaned from vasopressor and ventilator by day 2 and extubated. She became awake; labetalol and magnesium sulphate infusions were stopped by day 3. The patient was transferred to the ward on day 5; from there she was discharged home on day 8 on oral labetalol. She was followed up in an outpatient clinic after 4 weeks and remained comfortable, and blood pressure was controlled with tablet labetalol and repeat echocardiogram was normal. Conclusion. Eclampsia patients can have apnea after seizures, progressing to SCA.

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The dependence of successful resuscitation on electrocardiographically documented cardiac rhythm in case of out-of-hospital cardiac arrest

Medicina ◽

10.3390/medicina43100102 ◽

2007 ◽

Vol 43 (10) ◽

pp. 798 ◽

Cited By ~ 4

Author(s):

Nedas Jasinskas ◽

Dinas Vaitkaitis ◽

Vidas Pilvinis ◽

Lina Jančaitytė ◽

Gailutė Bernotienė ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Cardiac Rhythm ◽

Sudden Cardiac Arrest ◽

Spontaneous Circulation ◽

Consensus Conference ◽

Successful Resuscitation ◽

Initial Rhythm ◽

Hospital Deaths ◽

One Year

Objective. To determine the influence of electrocardiographically documented cardiac rhythm during sudden cardiac arrest on successful resuscitation among out-of-hospital deaths in Kaunas city. Material and methods. An observational prospective study was conducted between 1 January, 2005, and 30 December, 2005, in Kaunas city with a population of 360 627 inhabitants. In this period, all cases of cardiac arrest were analyzed according to the guidelines of the Utstein consensus conference. Cardiac arrest (both of cardiac and noncardiac etiology) was confirmed in 72 patients during one year. Effective cardiopulmonary resuscitation was performed in 18 patients. Results. The total number of deaths from all causes in Kaunas during 1-year study period was 6691. Sixty-two patients due to sudden death of cardiac etiology were resuscitated by emergency medical services personnel. Return of spontaneous circulation was achieved in 11 patients. Ventricular fibrillation was observed in 33 (53.2%) patients. Asystole was present in 11 (17.7%) and other rhythms in 18 (29.1%) cases. Patients with ventricular fibrillation as an initial rhythm were more likely to be successfully resuscitated than patients with asystole. Conclusions. Ventricular fibrillation was the most common electrocardiographically documented cardiac rhythm registered during cardiac arrest in out-of-hospital settings. Ventricular fibrillation as a mechanism of cardiac arrest was associated with major cases of successful resuscitation.

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Hipotermia terapêutica pós reanimação cardiorrespiratória: uma revisão bibliográfica

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/2177-157x.2013.3.8.25-35 ◽

2013 ◽

pp. 25

Author(s):

Jaciana Emily de Souza

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Therapeutic Hypothermia ◽

Neurological Complications ◽

Recovery Phase ◽

Spontaneous Circulation ◽

The Body ◽

Cardiorespiratory Arrest ◽

Palabras Clave ◽

The Central Nervous System

A hipotermia, estado de anormalidade no ser humano em que a temperatura está abaixo do normal, é o resultado da exposição do organismo ao frio intenso, independente da forma, quando os mecanismos reguladores, cutâneos e nervosos se exaurem rapidamente e a temperatura cai, a produção de calor é deprimida e o resfriamento do sistema nervoso central leva à supressão dos controles hipotalâmicos. A hipotermia terapêutica melhora os desfechos entre os sobreviventes comatosos após manobras de reanimação. Considerando sua recomendação formal para emprego terapêutico pós-recuperação da circulação espontânea na parada cardiorrespiratória, o objetivo deste estudo foi trazer as principais teorias relacionadas com a hipotermia terapêutica. A revisão foi feita através de pesquisa de artigos através das palavras-chave parada cardiorrespiratória, resfriamento, hipotermia, na base de dados eletrônicos. Os resultados revelou que a hipotermia terapêutica é um dos tratamentos mais bem sucedidas para a fase após recuperação da parada cardíaca, aumentando em 40% a chance do paciente ter alta sem complicações neurológicas maiores.Descritores: Hipotermia, Parada Cardiorrespiratória, Ressuscitação Cardiopulmonar. Therapeutic hypothermia after cardiopulmonary resuscitation: a literature reviewAbstract: Hypothermia, state of abnormality in humans in which the temperature is below normal, is the result of exposure of the body to intense cold, regardless of form, when regulators, skin and nervous mechanisms are exhausted quickly and the temperature drops, the heat production is depressed and the cooling of the central nervous system leads to suppression of hypothalamic controls. Therapeutic hypothermia improves outcomes in comatose survivors after resuscitation maneuvers. Considering its formal recommendation for therapy, post-return of spontaneous circulation after cardiac arrest, the objective of this study was to bring the main theories related to therapeutic hypothermia. The review was conducted by searching items via keywords cardiorespiratory arrest, cooling, hypothermia, on the basis of electronic data. The results showed that therapeutic hypothermia is one of the most successful treatments for the recovery phase after cardiac arrest, increasing by 40% the chance of the patient being discharged without major neurological complications. Descriptors: Hypothermia, Stop Cardiopulmonary, Cardiopulmonary Resuscitation. La hipotermia terapêutica tras la reanimación cardiopulmonar: una revisión de la literaturaResumen: La hipotermia, estado de anormalidad en los seres humanos en los que la temperatura es inferior a lo normal, es el resultado de la exposición del cuerpo al frío intenso, independientemente de su forma, cuando los reguladores, la piel y los mecanismos nerviosos se agotan rapidamente y la temperatura baja, el la producción de calor es deprimida y el esfriamiento del sistema nervioso central conduce a la supresión de los controles hipotalámicos. La hipotermia terapéutica mejora los resultados en los supervivientes comatosos tras las maniobras de reanimación. Teniendo en cuenta su recomendación formal para la terapia, después de la recuperación de la circulación espontánea después de un paro cardíaco, el objetivo de este estudio fue el de traer las principales teorías relacionadas con la hipotermia terapéutica. La revisión se llevó a cabo mediante la búsqueda a través de palabras clave artículos parada cardiorrespiratoria, la refrigeración, la hipotermia, sobre la base de los datos electrónicos. Los resultados mostraron que la hipotermia terapéutica es uno de los tratamientos más exitosos para la fase de recuperación después de un paro cardíaco, aumentando en un 40% la posibilidad de que el paciente que está siendo descargada sin mayores complicaciones neurológicas. Descriptores: Hipotermia, Parada Cardiopulmonar, Resucitación Cardiopulmonar.

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Hipotermia terapêutica pós reanimação cardiorrespiratória: uma revisão bibliográfica

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2177-157x.2013.3.8.25-35 ◽

2013 ◽

Vol 3 (8) ◽

pp. 25

Author(s):

Jaciana Emily de Souza

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Therapeutic Hypothermia ◽

Neurological Complications ◽

Recovery Phase ◽

Spontaneous Circulation ◽

The Body ◽

Cardiorespiratory Arrest ◽

Palabras Clave ◽

The Central Nervous System

A hipotermia, estado de anormalidade no ser humano em que a temperatura está abaixo do normal, é o resultado da exposição do organismo ao frio intenso, independente da forma, quando os mecanismos reguladores, cutâneos e nervosos se exaurem rapidamente e a temperatura cai, a produção de calor é deprimida e o resfriamento do sistema nervoso central leva à supressão dos controles hipotalâmicos. A hipotermia terapêutica melhora os desfechos entre os sobreviventes comatosos após manobras de reanimação. Considerando sua recomendação formal para emprego terapêutico pós-recuperação da circulação espontânea na parada cardiorrespiratória, o objetivo deste estudo foi trazer as principais teorias relacionadas com a hipotermia terapêutica. A revisão foi feita através de pesquisa de artigos através das palavras-chave parada cardiorrespiratória, resfriamento, hipotermia, na base de dados eletrônicos. Os resultados revelou que a hipotermia terapêutica é um dos tratamentos mais bem sucedidas para a fase após recuperação da parada cardíaca, aumentando em 40% a chance do paciente ter alta sem complicações neurológicas maiores.Descritores: Hipotermia, Parada Cardiorrespiratória, Ressuscitação Cardiopulmonar. Therapeutic hypothermia after cardiopulmonary resuscitation: a literature reviewAbstract: Hypothermia, state of abnormality in humans in which the temperature is below normal, is the result of exposure of the body to intense cold, regardless of form, when regulators, skin and nervous mechanisms are exhausted quickly and the temperature drops, the heat production is depressed and the cooling of the central nervous system leads to suppression of hypothalamic controls. Therapeutic hypothermia improves outcomes in comatose survivors after resuscitation maneuvers. Considering its formal recommendation for therapy, post-return of spontaneous circulation after cardiac arrest, the objective of this study was to bring the main theories related to therapeutic hypothermia. The review was conducted by searching items via keywords cardiorespiratory arrest, cooling, hypothermia, on the basis of electronic data. The results showed that therapeutic hypothermia is one of the most successful treatments for the recovery phase after cardiac arrest, increasing by 40% the chance of the patient being discharged without major neurological complications. Descriptors: Hypothermia, Stop Cardiopulmonary, Cardiopulmonary Resuscitation. La hipotermia terapêutica tras la reanimación cardiopulmonar: una revisión de la literaturaResumen: La hipotermia, estado de anormalidad en los seres humanos en los que la temperatura es inferior a lo normal, es el resultado de la exposición del cuerpo al frío intenso, independientemente de su forma, cuando los reguladores, la piel y los mecanismos nerviosos se agotan rapidamente y la temperatura baja, el la producción de calor es deprimida y el esfriamiento del sistema nervioso central conduce a la supresión de los controles hipotalámicos. La hipotermia terapéutica mejora los resultados en los supervivientes comatosos tras las maniobras de reanimación. Teniendo en cuenta su recomendación formal para la terapia, después de la recuperación de la circulación espontánea después de un paro cardíaco, el objetivo de este estudio fue el de traer las principales teorías relacionadas con la hipotermia terapéutica. La revisión se llevó a cabo mediante la búsqueda a través de palabras clave artículos parada cardiorrespiratoria, la refrigeración, la hipotermia, sobre la base de los datos electrónicos. Los resultados mostraron que la hipotermia terapéutica es uno de los tratamientos más exitosos para la fase de recuperación después de un paro cardíaco, aumentando en un 40% la posibilidad de que el paciente que está siendo descargada sin mayores complicaciones neurológicas. Descriptores: Hipotermia, Parada Cardiopulmonar, Resucitación Cardiopulmonar.

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Catecholamine Toxicity After Craniotomy and Evacuation of the Abscess

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4131 ◽

2020 ◽

Vol 8 (C) ◽

pp. 44-48

Author(s):

Wulan Fadinie ◽

Ongta Gibson Sirait

Keyword(s):

Cardiac Arrest ◽

Brain Abscess ◽

Vital Sign ◽

Rare Complication ◽

Sudden Cardiac Arrest ◽

Rare Event ◽

Spontaneous Circulation ◽

Brain Parenchyma ◽

Neonatal Meningitis ◽

Short Time

BACKGROUND: Brain abscess is a focal infection in the brain parenchyma, may be through direct extension or hematogenous. Brain abscess is a rare complication of neonatal meningitis that occurs in 1–4% of all cases. In infants and toddlers, bacterial meningitis or bacteremia is the major cause. CASE REPORT: In this case, the patient is diagnosed with a brain abscess since birth. According of the history, physical examination, and investigations, it was concluded the diagnosis of epidural abscess with abscess evacuation craniotomy and PS ASA 2 (leukocytosis) with GA-ETT anesthesia. The operation is carried out with a duration of 4 h. Vital sign monitoring obtained blood pressure 108–125/62–90 mmHg, heart frequency 90–120 times/min, and 99% oxygen saturation. When in the recovery room, the patient experiences cardiac arrest. Sudden cardiac arrest in children is a rare event. This is thought to result from catecholamine toxicity. Patient is treated as resuscitation in accordance with the algorithm of cardiac arrest in children. Patient experienced a response of spontaneous circulation and performed vital sign monitoring. CONCLUSION: Increasing levels of endogenous catecholamines occur acutely to provide short-time adaptation to stressful conditions. Catecholamine toxicity requires multidisciplinary management.

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H2O2-Responsive Antioxidant Nanoparticle Attenuates Whole Body Ischemia/Reperfusion-Induced Multi-Organ Damages

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248420969571 ◽

2020 ◽

pp. 107424842096957

Author(s):

Ruijian Li ◽

Sang Jae Rhee ◽

Soochan Bae ◽

Shi Su ◽

Chang-Sun Kang ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Ischemia Reperfusion ◽

Spontaneous Circulation ◽

Organ Injury ◽

Whole Body ◽

Ros Generation ◽

Vanillyl Alcohol ◽

Multiple Organs ◽

Significant Difference

Mortality and morbidity after cardiac arrest remain high due to ischemia/reperfusion (I/R) injury causing multi-organ damages, even after successful return of spontaneous circulation. We previously generated H2O2-activatable antioxidant nanoparticles formulated with copolyoxalate containing vanillyl alcohol (PVAX) to prevent I/R injury. In this study, we examined whether PVAX could effectively reduce organ damages in a rat model of whole-body ischemia/reperfusion injury (WBIR). To induce a cardiac arrest, 70µl/100 g body weight of 1 mmol/l potassium chloride was administered via the jugular venous catheter. The animals in both the vehicle and PVAX-treated groups had similar baseline blood pressure. After 5.5 minutes of cardiac arrest, animals were resuscitated via intravenous epinephrine followed by chest compressions. PVAX or vehicle was injected after the spontaneous recovery of blood pressure was noted, followed by the same dose of second injection 10 minutes later. After 24 hours, multiple organs were harvested for pathological, biochemical, molecular analyses. No significant difference on the restoration of spontaneous circulation was observed between vehicle and PVAX groups. Analysis of organs harvested 24 hours post procedure showed that whole body I/R significantly increased reactive oxygen species (ROS) generation, inflammatory markers, and apoptosis in multiple organs (heart, brain, and kidney). PVAX treatment effectively blocked ROS generation, reduced the elevation of pro-inflammatory cytokines, and decreased apoptosis in these organs. Taken together, our results suggest that PVAX has potent protective effect against WBIR induced multi-organ injury, possibly by blocking ROS-mediated cell damage.

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