scholarly journals A Case of Heart Transplantation after Ischaemic Preconditioning

2021 ◽  
Vol 21 ◽  
Author(s):  
Steve Micallef Eynaud ◽  
David Sladden ◽  
Alexander Manche
Keyword(s):  
Cardiac Arrest ◽  
Heart Transplantation ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Brain Mri ◽  
Immunosuppressive Treatment ◽  
Spontaneous Circulation ◽  
Uneventful Recovery ◽  
Unknown Quantity ◽  
Hypoxic Injury ◽  
Arterial Blood

A case of successful heart transplantation from a donor that suffered an out of hospital cardiac arrest lasting approximately one hour is presented. The recipient, a 27-year-old female nurse, was diagnosed with arrhythmogenic right ventricular cardiomyopathy in 2012. The donor was a 24-year-old male who after consuming an unknown quantity of alcohol and cocaine aboard a yacht was found floating face-down in the sea. The patient to be pulseless and CPR commenced after 7 minutes. The length of time that he spent in the sea was unknown. Return of spontaneous circulation (ROSC) occurred after 20 minutes of CPR on site. However, the patient arrested again in the ambulance and CPR was performed until he arrived Hospital, still in cardiac arrest. The patient arrested three more times before achieving a stable circulation. He was transferred to the intensive care unit on high doses of Noradrenaline and Adrenaline to maintain an adequate mean arterial blood pressure. An initial echocardiogram (ECHO) revealed a hypocontractile left ventricle (LV) with an estimated ejection fraction (EF) of 30%.Over the following 3 days the patient’s cardiac function improved. He was  weaned off inotropic support and a repeat ECHO showed a normal LV with an EF of 70%. A brain MRI showed diffuse swelling consistent with global hypoxic injury with wide areas of cortical and basal ganglia infarction. The patient’s parents gave their consent and he was offered for organ transplantation on day 6. The operation was successful, with the recipient making an uneventful recovery. She received immunosuppressive treatment with cyclosporine, prednisolone and azathioprine and experienced one episode of early mild rejection with full resolution. She remains well 8 months later. 

scholarly journals Massive pulmonary embolism in pregnancy: intra-arrest thrombolysis and resuscitative hysterotomy

2020 ◽  
Vol 13 (4) ◽  
pp. e234083 ◽  
Author(s):  
John Edward Ashbridge Taylor ◽  
Chen Wen Ngua ◽  
Matthew Carwardine
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Postmortem Examination ◽  
Right Heart ◽  
Hypoxic Injury ◽  
Injury Treatment ◽  
Ct Brain ◽  
Hospital Cardiac Arrest

Massive pulmonary embolism (PE) is a leading cause of maternal death and may require intra-arrest thrombolysis as well as resuscitative hysterotomy. The case presented is a primigravida in her mid-30s at 28 weeks gestation. The patient presented to the emergency department after out-of-hospital cardiac arrest. Return of spontaneous circulation (ROSC) was achieved but not sustained. Episodic cardiopulmonary resuscitation with epinephrine boluses was required. Resuscitative hysterotomy was performed intra-arrest. Echocardiography revealed a dilated right heart consistent with massive PE and thrombolysis was administered. ROSC was obtained thereafter and output was sustained. Subsequent CT brain revealed irreversible hypoxic injury. Treatment was withdrawn with the support of family. Postmortem examination confirmed massive PE. Thrombolysis can restore and improve cardiovascular status in cardiac arrest caused by massive PE. Thrombolysis is not contraindicated in maternal resuscitation where resuscitative hysterotomy may also be required.

scholarly journals The effect of high-dose intramuscular epinephrine on the recovery of spontaneous circulation in an asphyxia‐induced cardiac arrest rat model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daesung Lim ◽  
Soo Hoon Lee ◽  
Dong Hoon Kim ◽  
Changwoo Kang ◽  
Jin Hee Jeong ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Rat Model ◽  
Saline Group ◽  
Spontaneous Circulation ◽  
Rank Test ◽  
High Dose ◽  
Sprague Dawley ◽  
Epinephrine Administration ◽  
Arterial Blood ◽  
Induced Cardiac Arrest

Abstract Background Obtaining vascular access can be challenging during resuscitation following cardiac arrest, and it is particularly difficult and time-consuming in paediatric patients. We aimed to compare the efficacy of high-dose intramuscular (IM) versus intravascular (IV) epinephrine administration with regard to the return of spontaneous circulation (ROSC) in an asphyxia-induced cardiac arrest rat model. Methods Forty-five male Sprague-Dawley rats were used for these experiments. Cardiac arrest was induced by asphyxia, and defined as a decline in mean arterial pressure (MAP) to 20 mmHg. After asphyxia-induced cardiac arrest, the rats were randomly allocated into one of 3 groups (control saline group, IV epinephrine group, and IM epinephrine group). After 540 s of cardiac arrest, cardiopulmonary resuscitation was performed, and IV saline (0.01 cc/kg), IV (0.01 mg/kg, 1:100,000) epinephrine or IM (0.05 mg/kg, 1:100,000) epinephrine was administered. ROSC was defined as the achievement of an MAP above 40 mmHg for more than 1 minute. Rates of ROSC, haemodynamics, and arterial blood gas analysis were serially observed. Results The ROSC rate (61.5%) of the IM epinephrine group was less than that in the IV epinephrine group (100%) but was higher than that of the control saline group (15.4%) (log-rank test). There were no differences in MAP between the two groups, but HR in the IM epinephrine group (beta coefficient = 1.02) decreased to a lesser extent than that in the IV epinephrine group with time. Conclusions IM epinephrine induced better ROSC rates compared to the control saline group in asphyxia-induced cardiac arrest, but not compared to IV epinephrine. The IM route of epinephrine administration may be a promising option in an asphyxia-induced cardiac arrest.

scholarly journals Comparing anesthesia with isoflurane and fentanyl/fluanisone/midazolam in a rat model of cardiac arrest

2017 ◽  
Vol 123 (4) ◽  
pp. 867-875 ◽  
Author(s):  
Niels Secher ◽  
Christian Lind Malte ◽  
Else Tønnesen ◽  
Leif Østergaard ◽  
Asger Granfeldt
Keyword(s):  
Cardiac Arrest ◽  
Reperfusion Injury ◽  
Perfusion Pressure ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Coronary Perfusion Pressure ◽  
Spontaneous Circulation ◽  
Coronary Perfusion ◽  
Return Of Spontaneous Circulation ◽  
Arterial Blood

Only one in ten patients survives cardiac arrest (CA), underscoring the need to improve CA management. Isoflurane has shown cardio- and neuroprotective effects in animal models of ischemia-reperfusion injury. Therefore, the beneficial effect of isoflurane should be tested in an experimental CA model. We hypothesize that isoflurane anesthesia improves short-term outcome following resuscitation from CA compared with a subcutaneous fentanyl/fluanisone/midazolam anesthesia. Male Sprague-Dawley rats were randomized to anesthesia with isoflurane ( n = 11) or fentanyl/fluanisone/midazolam ( n = 11). After 10 min of asphyxial CA, animals were resuscitated by mechanical chest compressions, ventilations, and epinephrine and observed for 30 min. Hemodynamics, including coronary perfusion pressure, systemic O2 consumption, and arterial blood gases, were recorded throughout the study. Plasma samples for endothelin-1 and cathecolamines were drawn before and after CA. Compared with fentanyl/fluanisone/midazolam anesthesia, isoflurane resulted in a shorter time to return of spontaneous circulation (ROSC), less use of epinephrine, increased coronary perfusion pressure during cardiopulmonary resusitation, higher mean arterial pressure post-ROSC, increased plasma levels of endothelin-1, and decreased levels of epinephrine. The choice of anesthesia did not affect ROSC rate or systemic O2 consumption. Isoflurane reduces time to ROSC, increases coronary perfusion pressure, and improves hemodynamic function, all of which are important parameters in CA models. NEW & NOTEWORTHY The preconditioning effect of volatile anesthetics in studies of ischemia-reperfusion injury has been demonstrated in several studies. This study shows the importance of anesthesia in experimental cardiac arrest studies as isoflurane raised coronary perfusion pressure during resuscitation, reduced time to return of spontaneous circulation, and increased arterial blood pressure in the post-cardiac arrest period. These effects on key outcome measures in cardiac arrest research are important in the interpretation of results from animal studies.

scholarly journals Hemodynamic and Metabolic Parameters During Prolonged Cardiac Arrest and Reperfusion by Extracorporeal Circulation

2012 ◽  
pp. S57-S65
Author(s):  
M. MLČEK ◽  
P. OŠŤÁDAL ◽  
J. BĚLOHLÁVEK ◽  
Š. HAVRÁNEK ◽  
M. HRACHOVINA ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Plasma Potassium ◽  
Mean Amplitude ◽  
Spontaneous Circulation ◽  
Metabolic Parameters ◽  
Arterial Blood ◽  
Organ Specific ◽  
Early Effects ◽  
Electrical Activities ◽  
Support Devices

Extracorporeal membranous oxygenation (ECMO) is increasingly used in the management of refractory cardiac arrest. Our aim was to investigate early effects of ECMO after prolonged cardiac arrest. In fully anesthetized swine (48 kg, N=18) ventricular fibrillation (VF) was induced and untreated period (20 min) of cardiac arrest commenced, followed by 60 min extracorporeal reperfusion (ECMO flow 100 ml/kg.min). Hemodynamics, arterial blood gasses, plasma potassium, tissue oximetry (StO2) and cardiac (EGM) and cerebral (BIS) electrophysiological parameters were continuously recorded and analyzed. Within 3 minutes of VF hemodynamic and oximetry parameters fall abruptly while metabolic parameters destabilize gradually over 20 minutes peaking at pH 7.04±0.05, pCO2 89±14 mmHg, K+ 8.5±1.6 mmol/l. During reperfusion most parameters restore rapidly: within 3-5 minutes mean arterial pressure reaches >40 mmHg, StO2>50 %, paO2>100 mmHg, pCO2<50 mmHg, K+<5 mmol/l. EGMs mean amplitude peaks at 4.5±2.4 min. Cerebral activity (BIS>60) reappeared in 5 animals after 87±21 min. In 12/18 animals return of spontaneous circulation was achieved. In conclusions, ECMO provides rapid restitution of internal milieu even after prolonged arrest. However, despite normalization of global parameters full recovery was not guaranteed since cardiac and cerebral electrical activities were sufficiently restored only in some animals. More sensitive and organ specific indicators need to be identified in order to estimate adequacy of cardiac support devices.

Abstract 244: Preliminary Results on Angiotensin II as a Novel Vasopressor in Modeled Out-of-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Tobias Neumann ◽  
Simon-Richard Finke ◽  
Marlen Assam ◽  
Jakob Emrich ◽  
Alexander Fuchs ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Angiotensin Ii ◽  
Cardiopulmonary Resuscitation ◽  
Continuous Infusion ◽  
Position Statement ◽  
Spontaneous Circulation ◽  
Optimal Dosage ◽  
Arterial Blood ◽  
Distributive Shock ◽  
Hospital Cardiac Arrest

Introduction: The PARAMEDIC2-trial reported a higher survival rate comparing standard epinephrine treatment with placebo, but severe neurologic impairment was found more often in patients who received epinephrine. Angiotensin II (AT2) has been recently authorized by FDA and EMA to treat distributive shock in adults. It is not approved as a vasopressor in the treatment of cardiac arrest (CA) and has not been studied in a standardized model of out-of hospital cardiac arrest with subsequent guideline-based cardiopulmonary resuscitation (CPR) before. Hypothesis: AT2 administration during CPR will 1. result in higher rates for return of spontaneous circulation (ROSC) after modeled out-of-hospital CA and 2. will achieve a greater increase in mean arterial blood pressure (MAP) compared to standard epinephrine bolus regimen. Methods: After legal approval (81-02.04.2019A072) and in conformance with the AHA position statement (Circulation 1985; 71:849A), we conducted a prospective, randomized trial in 25 swine weighing 32 to 43.5 kilogram bodyweight (kgBW) under general anesthesia. In 22 swine randomized to intervention groups i) EPI or ii) AT2, ventricular fibrillation was induced electrically and mechanical ventilation was discontinued. After 10 minutes (min) of untreated CA, ventilation was resumed and CPR was performed adapted to current guidelines for up to 56 min. After the third unsuccessful defibrillation (6 min CPR), swine received either i) boluses of epinephrine 0.01 mg/kgBW every 4 min or ii) an initial bolus of AT2 (25 μg/kgBW) followed by continuous infusion at 1 μg/kgBW/min. Three animals served as sham controls and received identical treatment but neither CA nor CPR. Results: ROSC was achieved in 7/22 swine and in 5/20 requiring vasopressors (EPI 1/10 vs. AT2 4/10, n. s.). The initial vasopressor bolus increased MAP significantly more in AT2 compared to EPI (p = 0.03). However, this could not be maintained under continuous infusion of AT2. Conclusions: For the first time, we have demonstrated the feasibility of successful guideline-based CPR using AT2 as sole vasopressor. But still, questions such as the optimal dosage remain. We strongly encourage larger trials to investigate this newly available drug also for the treatment of CA.

scholarly journals REBOA-Assisted Resuscitation in Non-Traumatic Cardiac Arrest due to Massive Pulmonary Embolism: A Case Report with Physiological and Practical Reflections

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Philippe Rola ◽  
Philippe St-Arnaud ◽  
Karimov Timur ◽  
Jostein Rødseth Brede
Keyword(s):  
Cardiac Arrest ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Balloon Occlusion ◽  
Cerebral Oximetry ◽  
Traumatic Cardiac Arrest ◽  
Arterial Blood ◽  
End Tidal ◽  
Hospital Cardiac Arrest ◽  
End Tidal Co2

We present the case of a 36-year old woman who suffered a non-traumatic out-of-hospital cardiac arrest. The resuscitation attempt included the use of a resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter which resulted in a return of spontaneous circulation and distinct improvements in arterial blood pressure, end-tidal CO2 and cerebral oximetry values. This suggests that the use of REBOA may improve the rate of both survival and favorable neurologic outcome and warrants further study.

Association of Arterial Oxygen Tension During In-Hospital Cardiac Arrest With Return of Spontaneous Circulation and Survival

2016 ◽  
Vol 33 (7) ◽  
pp. 407-414 ◽  
Author(s):  
Jignesh K. Patel ◽  
Elinor Schoenfeld ◽  
Puja B. Parikh ◽  
Sam Parnia
Keyword(s):  
Cardiac Arrest ◽  
Oxygen Tension ◽  
Arterial Oxygen Tension ◽  
Spontaneous Circulation ◽  
Arterial Oxygen ◽  
Secondary Outcome ◽  
Return Of Spontaneous Circulation ◽  
Arterial Blood ◽  
The Impact ◽  
Hospital Cardiac Arrest

Background: Despite numerous advances in the delivery of resuscitative care, in-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. We sought to study the impact of arterial oxygen tension (Pao2) on return of spontaneous circulation (ROSC) and survival to discharge in patients with IHCA. Methods: The study population included 255 consecutive patients who underwent advanced cardiac life support–guided resuscitation from January 2012 to December 2013 for IHCA at an academic tertiary medical center. Of these patients, 167 underwent arterial blood gas testing at the time of the arrest. Baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was survival to hospital discharge. Secondary outcome of interest was presence of ROSC. Results: Of the 167 patients studied, Pao2 categorization included the following: Pao2 < 60 mm Hg (n = 38), Pao2 of 60-92 mm Hg (n = 44), Pao2 of 93 to 159 mm Hg (n = 43), Pao2 of 160 to 299 mm Hg (n = 24), and Pao2 ≥ 300 mm Hg (n = 18). Patients with higher Pao2 levels during the time of cardiac arrest were noted to have higher rates of hypertension and chronic kidney disease. Clinical presentation of IHCA, in particular, the initial rhythm, location of IHCA, and duration of cardiopulmonary resuscitation, was similar in all groups. Patients with higher Pao2 levels had higher platelet count, higher arterial pH, and lower arterial carbon dioxide tension (Pco2). With respect to outcomes, patients with higher intra-arrest Pao2 levels had progressively higher rates of ROSC (58% vs 71% vs 72% vs 79% vs 100%, P = .021) and survival to discharge (16% vs 23% vs 30% vs 33% vs 56%, P = .031). In multivariate analysis, Pao2 ≥ 300 mm Hg was independently associated with higher survival to discharge (odds ratio 60.68; 95% confidence interval: 3.04-1210.28; P = .007; referent Pao2 < 60 mm Hg). Conclusion: Higher intra-arrest Pao2 is independently associated with higher rates of survival to discharge in adults with IHCA.

scholarly journals Temperature post out-of-hospital cardiac arrest: the TOPCAT study

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A6.1-A6
Author(s):  
Richard Lyon
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Prospective Observational Study ◽  
Spontaneous Circulation ◽  
Single Centre ◽  
Oesophageal Temperature ◽  
Arterial Blood ◽  
The Relationship ◽  
Hospital Cardiac Arrest

IntroductionOut-of-hospital cardiac arrest (OHCA) is a significant cause of death and severe neurological disability. The only postreturn of spontaneous circulation (ROSC) therapy shown to increase survival is mild therapeutic hypothermia (MTH). The relationship between body temperature post OHCA and outcome is still poorly defined.MethodsProspective observational study of all OHCA patients admitted to a single centre for a 14-month period. Oesophageal temperature was measured in the Emergency Department and Intensive Care Unit (ICU). Select patients had prehospital temperature monitoring.Results164 OHCA patients were included in the study. 105 (64.0%) were pronounced dead in the Emergency Department. 59 (36.0%) were admitted to ICU for cooling; 40 (24.4%) died in ICU and 19 (11.6%) survived to hospital discharge. Patients who achieved ROSC and had oesophageal temperature measured prehospital (n=29) had a mean prehospital temperature of 33.9°C (95% CI 33.2 to 34.5). All patients arriving in the ED post OHCA had a relatively low oesophageal temperature (34.3°C, 95% CI 34.1 to 34.6). Patients surviving to hospital discharge were warmer on admission to ICU than patients who died in hospital (35.7°C vs 34.3°C, p<0.05). Patients surviving to hospital discharge also took longer to reach target MTH temperature than non-survivors (2 h 48 min vs 1 h 32 min, p<0.05). There was no difference in mean arterial blood pressure on arrival in the ED between survivors and non-survivors.ConclusionsFollowing OHCA all patients have oesophageal temperatures below normal in the prehospital phase and on arrival in the Emergency Department. This questions the need for prehospital cooling post-OHCA patients. Patients who achieve ROSC following OHCA and survive to hospital discharge are warmer on arrival in ICU and take longer to reach target MTH temperatures compared to patients who die in hospital. The mechanisms of action underlying oesophageal temperature and survival from OHCA remain unclear and further research is warranted to clarify this relationship.

scholarly journals Monocyte subsets predict mortality after cardiac arrest

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.A Krychtiuk ◽  
M Lenz ◽  
B Richter ◽  
K Huber ◽  
J Wojta ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Spontaneous Circulation ◽  
Strong Increase ◽  
Funding Source ◽  
Monocyte Subset ◽  
Male Mortality ◽  
National Budget ◽  
Classical Monocytes ◽  
Intermediate Monocytes ◽  
Subset Distribution

Abstract Background After successful cardiopulmonary resuscitation with return of spontaneous circulation (ROSC), many patients show signs of an overactive immune activation. Monocytes are a heterogenous cell population that can be distinguished into three subsets. Purpose The aim of this prospective, observational study was to analyze whether monocyte subset distribution is associated with mortality at 6 months in patients after cardiac arrest. Methods We included 53 patients admitted to our medical ICU after cardiac arrest. Blood was taken on admission and monocyte subset distribution was analyzed by flow cytometry and distinguished into classical monocytes (CM; CD14++CD16-), intermediate monocytes (IM; CD14++CD16+CCR2+) and non-classical monocytes (NCM; CD14+CD16++CCR2-). Results Median age was 64.5 (IQR 49.8–74.3) years and 75.5% of patients were male. Mortality at 6 months was 50.9% and survival with good neurological outcome was 37.7%. Of interest, monocyte subset distribution upon admission to the ICU did not differ according to survival. However, patients that died within 6 months showed a strong increase in the pro-inflammatory subset of intermediate monocytes (8.3% (3.8–14.6)% vs. 4.1% (1.5–8.2)%; p=0.025), and a decrease of classical monocytes (87.5% (79.9–89.0)% vs. 90.8% (85.9–92.7)%; p=0.036) 72 hours after admission. In addition, intermediate monocytes were predictive of outcome independent of initial rhythm and time to ROSC and correlated with the CPC-score at 6 months (R=0.32; p=0.043). Discussion Monocyte subset distribution is associated with outcome in patients surviving a cardiac arrest. This suggests that activation of the innate immune system may play a significant role in patient outcome after cardiac arrest. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): FWF - Fonds zur Förderung der wissenschaftlichen Forschung

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