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

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 ◽  
Major Public Health Problem ◽  
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

Brain Natriuretic Peptide as a Marker of Adverse Neurological Outcomes Among Survivors of Cardiac Arrest

2021 ◽  
pp. 088506662110347
Author(s):  
Abhishek Dutta ◽  
Zaid Alirhayim ◽  
Youssef Masmoudi ◽  
John Azizian ◽  
Lawson McDonald ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Neurological Status ◽  
Modified Rankin Scale ◽  
Neurological Disability ◽  
Neurological Outcomes ◽  
All Cause Mortality ◽  
Neurological Prognosis

Background Neurological prognosis after cardiac arrest remains ill-defined. Plasma brain natriuretic peptide (BNP) may relate to poor neurological prognosis in brain-injury patients, though it has not been well studied in survivors of cardiac arrest. Methods We performed a retrospective review and examined the association of BNP with mortality and neurological outcomes at discharge in a cohort of cardiac arrest survivors enrolled from January 2012 to December 2016 at the Wake Forest Baptist Hospital, in North Carolina. Cerebral performance category (CPC) and modified Rankin scales were calculated from the chart based on neurological evaluation performed at the time of discharge. The cohort was subdivided into quartiles based on their BNP levels after which multivariable adjusted logistic regression models were applied to assess for an association between BNP and poor neurological outcomes as defined by a CPC of 3 to 4 and a modified Rankin scale of 4 to 5. Results Of the 657 patients included in the study, 254 patients survived until discharge. Among these, poor neurological status was observed in 101 (39.8%) patients that had a CPC score of 3 to 4 and 97 patients (38.2%) that had a modified Rankin scale of 4 to 5. Mean BNP levels were higher in patients with poor neurological status compared to those with good neurological status at discharge ( P = .03 for CPC 3-4 and P = .02 for modified Rankin score 4-5). BNP levels however, did not vary significantly between patients that survived and those that expired ( P = .22). BNP did emerge as a significant discriminator between patients with severe neurological disability at discharge when compared to those without. The area under the curve for BNP predicting a modified Rankin score of 4 to 5 was 0.800 (95% confidence interval [CI] 0.756-0.844, P < .001) and for predicting CPC 3 to 4 was 0.797 (95% CI 0.756-0.838, P < .001). BNP was able to significantly improve the net reclassification index and integrated discriminatory increment ( P < .05). BNP was not associated with long-term all-cause mortality ( P > .05). Conclusions In survivors of either inpatient or out-of-hospital cardiac arrest, increased BNP levels measured at the time of arrest predicted severe neurological disability at discharge. We did not observe an independent association between BNP levels and long-term all-cause mortality. BNP may be a useful biomarker for predicting adverse neurological outcomes in survivors of cardiac arrest.

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 ◽  
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 ◽  
Major Public Health Problem ◽  
Favorable Neurological Outcome ◽  
The Relationship ◽  
Hospital Cardiac Arrest

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.

scholarly journals Predictors of Survival from Perioperative Cardiopulmonary Arrests

2013 ◽  
Vol 119 (6) ◽  
pp. 1322-1339 ◽  
Author(s):  
Satya Krishna Ramachandran ◽  
Jill Mhyre ◽  
Sachin Kheterpal ◽  
Robert E. Christensen ◽  
Kristen Tallman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Operating Room ◽  
Hospital Discharge ◽  
Ventilatory Support ◽  
Neurological Status ◽  
Secondary Outcome ◽  
Postanesthesia Care Unit ◽  
Neurologically Intact

Abstract Background: Perioperative cardiopulmonary arrests are uncommon and little is known about rates and predictors of in-hospital survival. Methods: Using the Get With The Guidelines®-Resuscitation national in-hospital resuscitation registry, we identified all patients aged 18 yr or older who experienced an index, pulseless cardiac arrest in the operating room or within 24 h postoperatively. The primary outcome was survival to hospital discharge, and the secondary outcome was neurologically intact recovery among survivors. Multivariable logistic regression models using generalized estimating equation models were used to identify independent predictors of survival and neurologically intact survival. Results: A total of 2,524 perioperative cardiopulmonary arrests were identified from 234 hospitals. The overall rate of survival to discharge was 31.7% (799/2,524), including 41.8% (254/608) for ventricular tachycardia and ventricular fibrillation, 30.5% (296/972) for asystole, and 26.4% (249/944) for pulseless electrical activity. Ventricular fibrillation and pulseless ventricular tachycardia were independently associated with improved survival. Asystolic arrests occurring in the operating room and postanesthesia care unit were associated with improved survival when compared to other perioperative locations. Among patients with neurological status assessment at discharge, the rate of neurologically intact survival was 64.0% (473/739). Prearrest neurological status at admission, patient age, inadequate natural airway, prearrest ventilatory support, duration of event, and event location were significant predictors of neurological status at discharge. Conclusion: Among patients with a perioperative cardiac arrest, one in three survived to hospital discharge, and good neurological outcome was noted in two of three survivors.

Abstract 368: A Cardiac Arrest Simulation-Based Feasibility Cadaver Study Investigating Time for Semi Surgical Cut Down Procedure Followed by Insertion of a Novel REBOA Catheter

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Helene Duhem ◽  
Lionel Lamhaut ◽  
Alice Hutin ◽  
Alexandre Bellier ◽  
Stephane Tanguy ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Median Time ◽  
Life Support ◽  
Advanced Life Support ◽  
Public Health Problem ◽  
Balloon Occlusion ◽  
Major Public Health Problem ◽  
Introducer Sheath ◽  
Human Cadavers ◽  
Time Required

Aim: Non-traumatic cardiac arrest is a major public health problem that carries an extremely high mortality rate. The Resuscitative endovascular balloon occlusion of the aorta (REBOA) procedure is currently being discussed as a possible technique to be used during Advanced Life Support (ALS) in humans with Cardiac arrest (CA). The aim of this study was to assess the training of emergency physicians in the procedures related to insertion of a novel REBOA catheter. Methods: We developed a training program using a simulated CA model on human cadavers. CPR was performed using the LUCAS device (Stryker/Jolife AB, Lund, Sweden). All cadavers were hemodynamically monitored. The Neurescue REBOA catheter (Neurescue REBOA device, Neurescue ApS, Copenhagen, Denmark) was inserted using a semi-surgical cut-down and sheath placement technique. Time needed to perform the procedures was measured. The procedures were instructed by 2 experts using video, procedural simulation on manikin and full-scale training on cadavers. Results: Six human cadavers were enrolled and a total of 12 procedures were performed by 2 expert investigators and 10 novice investigators. Eight semi-surgical cut-down producers including placements of the introducer sheath were performed on the first attempt and 4 required a second attempt. The median time required for the semi-surgical cutdown procedure and sheath placement by the novice investigators was: 6 min 48 sec (Min: 3 min 45 sec and Max: 26 min 25 sec). The median time required for the insertion and occlusion of the REBOA catheter by the novice investigators was: 3 min 22 sec (Min: 1 min 22 sec and Max: 7 min 5 sec). The median time required for full insertion for the novice investigators was: 11 min 14 sec (Min: 6 min 49 sec and Max: 28 min 15 sec). The mean aortic pressure during compression was: 31.9 mmHg (±17.0). Conclusions: Semi surgical cut-down and introducer sheath placement were performed in 1 or two 2 attempts for all novice investigators with an insertion time compatible with ALS during refractory CA. Simulation training on cadavers brings clinical realism and could be an important addition to the use of manikin or animal training models.

Low Energy Neurofeedback System Treatment of an Acquired Brain Injury due to Sudden Cardiac Arrest

Biofeedback ◽  
2009 ◽  
Vol 37 (3) ◽  
pp. 100-103
Author(s):  
Sara Hunt Harper
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Treatment Process ◽  
Brain Injuries ◽  
Sudden Cardiac Arrest ◽  
Public Health Problem ◽  
Acquired Brain Injury ◽  
Low Energy ◽  
Major Public Health Problem ◽  
System A

Abstract There is confusion regarding whether to identify brain injuries as a traumatic brain injury, an acquired brain injury, or a combination of both. No matter what you call it, brain injuries are a major public health problem. This article demonstrates the power of the Low Energy Neurofeedback System, a form of electroencephalography biofeedback/neurofeedback, with a 71-year-old woman who had a sudden cardiac arrest and was without pulse or respiration for 8 to 10 minutes. NeuroField and hyperbaric oxygen therapy were added later on in the treatment process.

scholarly journals Prognostic Value of Early Intermittent Electroencephalography in Patients after Extracorporeal Cardiopulmonary Resuscitation

2020 ◽  
Vol 9 (6) ◽  
pp. 1745 ◽  
Author(s):  
Yong Oh Kim ◽  
Ryoung-Eun Ko ◽  
Chi Ryang Chung ◽  
Jeong Hoon Yang ◽  
Taek Kyu Park ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Multivariable Analysis ◽  
Neurological Status ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Neurological Outcomes ◽  
Neurological Prognosis

The aim of this study was to investigate whether early intermittent electroencephalography (EEG) could be used to predict neurological prognosis of patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). This was a retrospective and observational study of adult patients who were evaluated by EEG scan within 96 h after ECPR. The primary endpoint was neurological status upon discharge from the hospital assessed with a Cerebral Performance Categories (CPC) scale. Among 69 adult cardiac arrest patients who underwent ECPR, 17 (24.6%) patients had favorable neurological outcomes (CPC score of 1 or 2). Malignant EEG patterns were more common in patients with poor neurological outcomes (CPC score of 3, 4 or 5) than in patients with favorable neurological outcomes (73.1% vs. 5.9%, p < 0.001). All patients with highly malignant EEG patterns (43.5%) had poor neurological outcomes. In multivariable analysis, malignant EEG patterns and duration of cardiopulmonary resuscitation were significantly associated with poor neurological outcomes. In this study, malignant EEG patterns within 96 h after cardiac arrest were significantly associated with poor neurological outcomes. Therefore, an early intermittent EEG scan could be helpful for predicting neurological prognosis of post-cardiac arrest patients after ECPR.

scholarly journals Sodium-Hydrogen Exchanger Isoform-1 Inhibition: A Promising Pharmacological Intervention for Resuscitation from Cardiac Arrest

Molecules ◽  
2019 ◽  
Vol 24 (9) ◽  
pp. 1765 ◽  
Author(s):  
Raúl J. Gazmuri ◽  
Jeejabai Radhakrishnan ◽  
Iyad M. Ayoub
Keyword(s):  
Cardiac Arrest ◽  
Animal Models ◽  
Myocardial Dysfunction ◽  
Sudden Cardiac Arrest ◽  
Cardiac Activity ◽  
Public Health Problem ◽  
Left Ventricular ◽  
Pharmacological Intervention ◽  
Major Public Health Problem ◽  
Electrical Stability

Out-of-hospital sudden cardiac arrest is a major public health problem with an overall survival of less than 5%. Upon cardiac arrest, cessation of coronary blood flow rapidly leads to intense myocardial ischemia and activation of the sarcolemmal Na+-H+ exchanger isoform-1 (NHE-1). NHE-1 activation drives Na+ into cardiomyocytes in exchange for H+ with its exchange rate intensified upon reperfusion during the resuscitation effort. Na+ accumulates in the cytosol driving Ca2+ entry through the Na+-Ca2+ exchanger, eventually causing cytosolic and mitochondrial Ca2+ overload and worsening myocardial injury by compromising mitochondrial bioenergetic function. We have reported clinically relevant myocardial effects elicited by NHE-1 inhibitors given during resuscitation in animal models of ventricular fibrillation (VF). These effects include: (a) preservation of left ventricular distensibility enabling hemodynamically more effective chest compressions, (b) return of cardiac activity with greater electrical stability reducing post-resuscitation episodes of VF, (c) less post-resuscitation myocardial dysfunction, and (d) attenuation of adverse myocardial effects of epinephrine; all contributing to improved survival in animal models. Mechanistically, NHE-1 inhibition reduces adverse effects stemming from Na+–driven cytosolic and mitochondrial Ca2+ overload. We believe the preclinical work herein discussed provides a persuasive rationale for examining the potential role of NHE-1 inhibitors for cardiac resuscitation in humans.

scholarly journals Is early surgical intervention effective for traumatic severe cervical spinal cord injury?

2021 ◽  
Author(s):  
Koji Yamamoto ◽  
akinori okuda ◽  
Naoki Maegawa ◽  
Hironobu Konishi ◽  
Keita Miyazaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Secondary Outcome ◽  
Respiratory Complications ◽  
Cord Injury ◽  
Neurological Prognosis

Abstract Background This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe cervical spinal cord injury (CSCI). Methods The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were divided into early surgery (< 24 h) and late surgery (> 24 h) groups. Using inverse probability of treatment weighting (IPTW) with propensity score adjustment for confounding factors, the AIS grade before and 1 month following surgical treatment as the primary outcome were compared. The secondary outcome was the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest. Results In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), ICU-LOS > 7 days (OR: 0.14 95% Cl: 0.02–0.90, p = 0.04), respiratory complications (OR: 0.08 95% Cl: 0.01–0.73, p = 0.03), and cardiac arrest (OR: 0.13 95% Cl: 0.02–0.85, p = 0.03). Conclusions Early surgery (within 24 h) for traumatic severe CSCI may be effective in improving the neurological prognosis, and preventing a long ICU-LOS and postoperative complications.

scholarly journals Is Early Surgical Intervention Effective for Traumatic Severe Cervical Spinal Cord Injury?

2021 ◽  
Author(s):  
Koji Yamamoto ◽  
Akinori Okuda ◽  
Naoki Maegawa ◽  
Hironobu Konishi ◽  
Keita Miyazaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Secondary Outcome ◽  
Respiratory Complications ◽  
Cord Injury ◽  
Neurological Prognosis

Abstract Background: It is unclear whether early surgery for traumatic severe cervical spinal cord injury (CSCI) improves neurological outcomes and reduces complications. This study aimed to determine whether surgery within 24 h improves the neurological prognosis of and reduces the complications associated with surgery for traumatic severe CSCI.Methods: The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were divided into early surgery (< 24 h) and late surgery (> 24 h) groups. With inverse probability of treatment weighting (IPTW) using a propensity score adjusted for confounding factors, we compared the AIS grade before and 1 month after surgical treatment as the primary outcome. The secondary outcome was the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest.Results: In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in neurological improvement according to the AIS grade at 1 month after surgery (odds ratio [OR]: 17.1 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), ICU-LOS > 7 days (OR: 0.14 95% Cl: 0.02–0.90, p = 0.04), respiratory complications (OR: 0.08 95% Cl: 0.01–0.73, p = 0.03), and cardiac arrest (OR: 0.13 95% Cl: 0.02–0.85, p = 0.03).Conclusion: Early surgery (within 24 h) for traumatic severe CSCI may be effective in improving the neurological prognosis and preventing a long ICU-LOS and postoperative complications.

scholarly journals Outcomes of patients presenting with central nervous system tuberculosis at a tertiary care center in India

2020 ◽  
Vol 8 (1) ◽  
pp. 138
Author(s):  
Santhosh Rajendran ◽  
Darshil Shah ◽  
Fatema Kapadia ◽  
Ruchi Jani ◽  
Jinal Pandya ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Public Health Problem ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Common Symptom ◽  
Major Public Health Problem ◽  
Tropical Regions ◽  
High Level

Background: Tuberculosis (TB) is a major public health problem in India. Ten percent of all patients with TB have CNS involvement.  Delayed diagnosis of this disease is associated with increased mortality. This study assesses the socio-demographic profile as well as outcomes in patients with various forms of CNS TB.  Methods: A prospective observational study conducted at V.S. Hospital, Ahmedabad, between December-2016 and February-2018. Each patient was assessed from admission to 3- month follow up. The diagnosis of tuberculous meningitis (TBM) and tuberculoma was done as per the Ahuja and Rajashekhar criteria, respectively. Neurological status and functional outcome were graded based on modified Rankin score (mRS).  Results: Our study had 56 patients with a mean age of 35.01±11.46 years.  We observed that increasing age was associated with higher mRS (p=0.002). Fever was the most common symptom in patients with TBM (96. 15%), unlike seizures (100%) in patients with tuberculomas with or without TBM. Patients with either isolated TBM or tuberculoma had improvement in outcomes. On multivariate analysis, it was found that CN palsy (HR=0.38, p=0.003), duration of illness (HR=0.35, p=0.005) and age (HR=0.33, p=0.008) were the most significant predictor of worse outcomes.  Conclusions: Identification and evaluation of focal signs like seizures and focal neurological deficits along with certain non-focal signs like headache and fever should raise high level of suspicion for TB in tropical regions at the primary care levels for early diagnosis and treatment.

Sign in / Sign up

Export Citation Format

Share Document