scholarly journals Proposed Mechanism-Based Risk Stratification and Algorithm to Prevent Sudden Death in Epilepsy

2021 ◽  
Vol 11 ◽  
Author(s):  
Michael Lucchesi ◽  
Joshua B. Silverman ◽  
Krishnamurthi Sundaram ◽  
Richard Kollmar ◽  
Mark Stewart
Keyword(s):  
Risk Stratification ◽  
Airway Management ◽  
Sudden Cardiac Arrest ◽  
First Aid ◽  
Emergency Setting ◽  
Unexpected Death ◽  
Near Misses ◽  
Airway Occlusion ◽  
Risk Of Death ◽  
Sequence Of Events

Sudden Unexpected Death in Epilepsy (SUDEP) is the leading cause of death in young adults with uncontrolled seizures. First aid guidance to prevent SUDEP, though, has not been previously published because the rarity of monitored cases has made the underlying mechanism difficult to define. This starkly contrasts with the first aid guidelines for sudden cardiac arrest that have been developed based on retrospective studies and expert consensus and the discussion of resuscitation challenges in various American Heart Association certificate courses. However, an increasing amount of evidence from documented SUDEP cases and near misses and from animal models points to a consistent sequence of events that starts with sudden airway occlusion and suggests a mechanistic basis for enhancing seizure first aid. In monitored cases, this sudden airway occlusion associated with seizure activity can be accurately inferred from inductance plethysmography or (depending on recording bandwidth) from electromyographic (EMG) bursts that are associated with inspiratory attempts appearing on the electroencephalogram (EEG) or the electrocardiogram (ECG). In an emergency setting or outside a hospital, seizure first aid can be improved by (1) keeping a lookout for sudden changes in airway status during a seizure, (2) distinguishing thoracic and abdominal movements during attempts to inspire from effective breathing, (3) applying a simple maneuver, the laryngospasm notch maneuver, that may help with airway management when aggressive airway management is unavailable, (4) providing oxygen early as a preventative step to reduce the risk of death, and (5) performing cardiopulmonary resuscitation before the limited post-ictal window of opportunity closes. We propose that these additions to first aid protocols can limit progression of any potential SUDEP case and prevent death. Risk stratification can be improved by recognition of airway occlusion, attendant hypoxia, and need for resuscitation.

scholarly journals First aid awareness in the society

2017 ◽  
Vol 11 (2) ◽  
pp. 4-9
Author(s):  
Ewelina Krzyszkowska ◽  
Bartosz Wanot
Keyword(s):  
Public Awareness ◽  
Sudden Cardiac Arrest ◽  
First Aid ◽  
Test Results ◽  
The Public ◽  
Good Level ◽  
Study Results ◽  
Study Population ◽  
On Line ◽  
Level Of Knowledge

Introduction: Every member of the society should possess first aid skills and knowledge thereof. Aim: The aim of the study was to determine public awareness of first aid, sudden cardiac arrest and the Automated External Defibrillator. Material and Methods: The study was conducted using an anonymous and voluntary on-line survey. The study population comprised of 250 subjects. The results were analysed using the t-Student test, F Test and Chi2 test. Results: The analysis of the study results showed that 164 respondents, who gave 9 to 11 correct answers, had a good level of knowledge. 80 respondents had the average level of knowledge, as shown by 6 to 8 correct answers. 6 respondents had insufficient level of knowledge, as they gave less than 6 correct answers to questions included in the survey. Conclusions: The principles and techniques on first aid are known to the public, as indicated by the fact that more than half of the respondents have a good level of knowledge.

scholarly journals Prognostic Significance of B Type Natriuretic Peptide in Acute Coronary Syndrome

2014 ◽  
Vol 13 (2) ◽  
pp. 78-88 ◽  
Author(s):  
Nasreen Chowdhury ◽  
Md. Aminul Haque Khan ◽  
Md Mozammel Hoque
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Natriuretic Peptide ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Early Risk

Acute Coronary syndrome (ACS) is the most common cause of admission to the coronary care unit with highest risk of death and adverse outcomes. ACS accounts for 60–70% of all admissions in the hospital. Patients with ACS encompass a heterogeneous group that varies widely regarding severity of the underlying coronary artery disease, prognosis and response to treatment. Patients with the highest risk of subsequent events usually have the largest benefit of an intensified pharmacological treatment and early mechanical intervention. The prognosis for low-risk patients, on the other hand, is often difficult to improve further and these patients usually benefit more from a conservative management with a lower risk of side effects. Therefore, risk stratification is essential and should be initiated early and updated continuously throughout the hospital stay. Early risk stratification is usually performed by the use of clinical background factors, clinical presentation, electrocardiography and biochemical markers of myocardial damage. Levels of natriuretic peptides have been shown to reflect cardiac performance. The aim of this study was to review elaborately on B type Natriuretic Peptide (BNP) and its prognostic value in patient with ACS. This review focuses on the emerging role of these peptides in the early risk stratification of ACS patients. Elevation of BNP levels in acute MI and UA is predictive of a greater risk of death, post infarction heart failure, or  reinfarction. Post infarction studies demonstrate that elevated plasma BNP levels are associated with larger infarct size, increased probability of ventricular remodeling, lower ejection fraction, higher risk of heart failure, and increased mortality. This cardiac marker is a potent predictor of mortality in patients with all forms ACS. BNP measurements serve as an index of severity of the ischemic injury, as well as the degree of impairment in left ventricular function.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21079

scholarly journals Risk Stratification for Heart Failure and Death in an Acute Coronary Syndrome Population Using Inflammatory Cytokines and N-Terminal Pro-Brain Natriuretic Peptide

2007 ◽  
Vol 53 (12) ◽  
pp. 2112-2118 ◽  
Author(s):  
Peter A Kavsak ◽  
Dennis T Ko ◽  
Alice M Newman ◽  
Glenn E Palomaki ◽  
Viliam Lustig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Risk Stratification ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Troponin I ◽  
Significant Risk ◽  
Risk Of Death ◽  
Coronary Syndrome

Abstract Background: Inflammation in acute coronary syndrome (ACS) can identify those at greater long-term risks for heart failure (HF) and death. The present study assessed the performance of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1) (cytokines involved in the activation and recruitment of leukocytes) in addition to known biomarkers [e.g., N-terminal pro-brain natriuretic peptide (NT-proBNP)] for predicting HF and death in an ACS population. Methods: In a cohort of 216 ACS patients, NT-proBNP (Elecsys®; Roche) and IL-6, IL-8, and MCP-1 (evidence investigator™; Randox) were measured in serial specimens collected early after symptom onset (n = 723). We collected at least 2 specimens from each participant: an early specimen (median 2 h; interquartile range 2–4 h) and a later specimen (9 h; 9–9 h), and used the later specimens’ biomarker concentrations for risk stratification. Results: An increase in both IL-6 and NT-proBNP was observed but not for IL-8 or MCP-1 early after pain onset. Kaplan–Meier analysis demonstrated that individuals with increased NT-proBNP (>183 ng/L) or cytokines (IL-6 > 6.4 ng/L; above upper limit of normal for IL-8 or MCP-1) had a greater probability of death or HF in the following 8 years (P <0.05). In a Cox proportional hazard model adjusted for both CRP and troponin I, increased IL-6, MCP-1, and NT-proBNP remained significant risk factors. Combining all 3 biomarkers resulted in a higher likelihood ratio for death or HF than models restricted to any 2 of these biomarkers. Conclusion: IL-6, MCP-1, and NT-proBNP are independent predictors of long-term risk of death or HF, highlighting the importance of identifying leukocyte activation and recruitment in ACS patients.

Anesthestic-related Cardiac Arrest and Its Mortality

2002 ◽  
Vol 97 (1) ◽  
pp. 108-115 ◽  
Author(s):  
Myrna C. Newland ◽  
Sheila J. Ellis ◽  
Carol A. Lydiatt ◽  
K. Reed Peters ◽  
John H. Tinker ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Confidence Interval ◽  
Airway Management ◽  
Central Venous Access ◽  
Venous Access ◽  
Medication Administration ◽  
Central Venous ◽  
Retrospective Case ◽  
Technical Problems ◽  
Risk Of Death

Background A prospective and retrospective case analysis study of all perioperative cardiac arrests occurring during a 10-yr period from 1989 to 1999 was done to determine the incidence, cause, and outcome of cardiac arrests attributable to anesthesia. Methods One hundred forty-four cases of cardiac arrest within 24 h of surgery were identified over a 10-yr period from an anesthesia database of 72,959 anesthetics. Case abstracts were reviewed by a Study Commission composed of external and internal members in order to judge which cardiac arrests were anesthesia-attributable and which were anesthesia-contributory. The rates of anesthesia-attributable and anesthesia-contributory cardiac arrest were estimated. Results Fifteen cardiac arrests out of a total number of 144 were judged to be related to anesthesia. Five cardiac arrests were anesthesia-attributable, resulting in an anesthesia-attributable cardiac arrest rate of 0.69 per 10,000 anesthetics (95% confidence interval, 0.085-1.29). Ten cardiac arrests were found to be anesthesia-contributory, resulting in an anesthesia-contributory rate of 1.37 per 10,000 anesthetics (95% confidence interval, 0.52-2.22). Causes of the cardiac arrests included medication-related events (40%), complications associated with central venous access (20%), problems in airway management (20%), unknown or possible vagal reaction in (13%), and one perioperative myocardial infarction. The risk of death related to anesthesia-attributable perioperative cardiac arrest was 0.55 per 10,000 anesthetics (95% confidence interval, 0.011-1.09). Conclusions Most perioperative cardiac arrests were related to medication administration, airway management, and technical problems of central venous access. Improvements focused on these three areas may result in better outcomes.

Prediction of sudden cardiac arrest: Risk stratification by anatomic substrate

1993 ◽  
Vol 126 (4) ◽  
pp. 807-815 ◽  
Author(s):  
Stephen C. Vlay ◽  
Lynn Burger ◽  
Linda C. Vlay ◽  
Owen Yen ◽  
Howard Novotny ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Risk Stratification ◽  
Sudden Cardiac Arrest

scholarly journals Renal dysfunction in patients with pulmonary embolism: data from the SIRENA register

2021 ◽  
Vol 26 (2S) ◽  
pp. 4422
Author(s):  
M. V. Menzorov ◽  
V. V. Filimonova ◽  
A. D. Erlikh ◽  
O. L. Barbarash ◽  
S. A. Berns ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Renal Dysfunction ◽  
Cox Regression ◽  
Russian Population ◽  
Hospital Death ◽  
Death Risk ◽  
Risk Of Death

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) <60 ml/ min/1,73 m2. Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR <50 ml/min/1,73 m2 reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; p<0,001). In patients with simplified Pulmonary Embolism Severity Index (sPESI) of 0 and ≥ 1, the presence of RD led to at least a 2-fold increase in mortality. Multivariate Cox regression revealed that RD is a predictor of in-hospital mortality (hazard ratio (HR), 3,41; 95% confidence interval (CI): 2,15-5,41; p<0,001), regardless of the presence of death risk reclassifies, such as high troponin (HR, 1,31; 95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (HR, 1,23; 95% CI: 0,74-2,04; p=0,42).Conclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR <60 ml/min/1,73 m2, to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.

scholarly journals Age-related differences in the prehospital management of 2,500 patients with sudden cardiac arrest

2021 ◽  
Author(s):  
Janusz Sielski ◽  
Karol Kaziród-Wolski ◽  
Marta Solnica ◽  
Mirosław Data ◽  
Dominika Kukla ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Urban Area ◽  
Older Patients ◽  
Prehospital Care ◽  
Age Groups ◽  
Sudden Cardiac Arrest ◽  
Risk Of Death ◽  
Shockable Rhythm ◽  
Age Related ◽  
Prehospital Management

IntroductionPrehospital care affects outcomes after out-of-hospital cardiac arrest (OHCA). The aim of the study is to analyze age-related differences in prehospital care and survival after OHCA and to define variables affecting the efficacy of cardiopulmonary resuscitation (CPR).Material and methodsAnalysis of differences in patient characteristics influencing the efficacy of CPR. Analysis of survival in four age groups: < 65, 65 - 74, 75 - 84, and ≥85. This retrospective registry-based study aimed to compare prehospital care in OHCA patients across age groups.ResultsCPR was performed in 2,500 patients, return of spontaneous circulation (ROSC) occurred in 1061 subjects. Of them, 339 had incomplete medical records, 201 survived at least 24 hours, 115 up to 30 days and 78 were alive at 365 days after discharge. The occurrence of shockable rhythms and the ROSC rate decreased with age. Overall mortality increased with age. Such factors as age, gender, urban area, home location, time to arrival, and witnessed OHCA were predictors of the initial shockable rhythm. Gender, urban area, OHCA witnessed by family member, time to arrival, cardiac cause and shockable rhythm were predictors of ROSC. The risk of death increased with each age group by about 56% (HR = 1.56, P < 0.0001).ConclusionsShockable initial rhythm and urban location were the strongest predictors of ROSC. Survival at 30 and 365 days after OHCA decreased in older patients. Survival among older patients with OHCA is worse as compared to younger subjects which results from lower efficacy of resuscitation and more frequent death declared upon arrival.

scholarly journals Cardiac risk stratification in stable coronary artery disease

The Clinician ◽  
2020 ◽  
Vol 14 (1-2) ◽  
pp. 24-33
Author(s):  
S. N. Tolpygina ◽  
S. Yu. Martsevich
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Myocardial Revascularization ◽  
Cardiovascular Complications ◽  
Prognostic Models ◽  
High Tech ◽  
Risk Of Death ◽  
Artery Disease ◽  
Stable Cad

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.

Sign in / Sign up

Export Citation Format

Share Document