Evaluation of initial shockable rhythm as an indicator of short no-flow time in cardiac arrest: a national registry study

BackgroundThe duration from collapse to initiation of cardiopulmonary resuscitation (no-flow time) is one of the most important determinants of outcomes after out-of-hospital cardiac arrest (OHCA). Initial shockable cardiac rhythm (ventricular fibrillation or ventricular tachycardia) is reported to be a marker of short no-flow time; however, there is conflicting evidence regarding the impact of initial shockable cardiac rhythm on treatment decisions. We investigated the association between initial shockable cardiac rhythm and the no-flow time and evaluated whether initial shockable cardiac rhythm can be a marker of short no-flow time in patients with OHCA.MethodsPatients aged 18 years and older experiencing OHCA between 2010 and 2016 were selected from a nationwide population-based Japanese database. The association between the no-flow time duration and initial shockable cardiac rhythm was evaluated. Diagnostic accuracy was evaluated using the sensitivity, specificity and positive predictive value.ResultsA total of 177 634 patients were eligible for the analysis. The median age was 77 years (58.3%, men). Initial shockable cardiac rhythm was recorded in 11.8% of the patients. No-flow time duration was significantly associated with lower probability of initial shockable cardiac rhythm, with an adjusted OR of 0.97 (95% CI 0.96 to 0.97) per additional minute. The sensitivity, specificity and positive predictive value of initial shockable cardiac rhythm to identify a no-flow time of <5 min were 0.12 (95% CI 0.12 to 0.12), 0.88 (95% CI 0.88 to 0.89) and 0.35 (95% CI 0.34 to 0.35), respectively. The positive predictive values were 0.90, 0.95 and 0.99 with no-flow times of 15, 18 and 28 min, respectively.ConclusionsAlthough there was a significant association between initial shockable cardiac rhythm and no-flow time duration, initial shockable cardiac rhythm was not reliable when solely used as a surrogate of a short no-flow time duration after OHCA.

Sedation-Paralysis as Cornerstone on Rabies Management (Milwaukee Protocol)

Rabies is a viral infection involving the central nervous system that is almost always fatal without proper post exposure prophylaxis. Here, we present a 38 years-old male with dog-bite and late attention whom, managed in intensive care unit. After 21 days, the disease progressed to serious neurologic and hemodynamic damage including motor disorders and imbalance in blood pressure and cardiac rhythm. Clinical management of the patient consisted of antiviral agents (Amantadine and Ribavirin), neuroprotection, sedation-paralysis and supportive care. Patient was survived 43 days from the clinical disease onset. Although our patient died in spite of intensive care, advances in the use of sedation-paralysis and early prescription of antiviral agents raised hopes that it may eventually be possible to save rabies patients.

Some psychophysiological parameters of a person during a passive orthostatic test

The study involved 14 volunteer students. Situational anxiety was determined, tests were carried out to determine simple and complex sensorimotor reactions, the cardiac rhythm of the subjects was recorded. Oxygen saturation was determined using an oximeter. Dynamic parameters were recorded: lying in a state of functional rest (background 1), vertical at 65-70° (vertical), lying after verticalization (horizontal), lying in a state of functional rest (background 2). The analysis of the data obtained was carried out using the Excel and StatPlus Pro programs. It was revealed that during verticalization, changes in the regulation of the heart activity of the subjects are carried out mainly due to the central mechanisms of regulation through the sympathetic nervous system. The transfer from a vertical to a horizontal state is accompanied by a restructuring of the regulatory system towards the activation of subcortical nerve centers and a shift in the balance of the SNS/PSNS towards the parasympathetic nervous system. Key words: passive orthostatic test, cardiac rhythm, simple sensorimotor reaction.

Investigation of the Effectiveness of Cortexin in the Treatment of Cardiac Arrhythmias in Children

In this article, a new look at cardiac rhythm and conduction disorders in children is outlined. These deviations, along with congenital malformations, have taken one of the first places in the structure of cardiovascular pathologies. This is one of the most serious problems that stands at the intersection of cardiology and pediatrics. The frequency of occurrence of severe forms of arrhythmias reaches 1:5000 of the child population, and life-threatening arrhythmias – 1:7000. Treatment of cardiac arrhythmias and conduction disorders is one of the most difficult sections of clinical pediatrics. There are medicinal and non-medicinal methods. According to experimental new data, nootropics, in particular the drug Cortexin, along with cardiotrophic drugs, form the basis of neuro-metabolic therapy and correction of children's arrhythmias.