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Hou J, Huang Z, Zeng W, Wu Z, Zhang L. Serum calcium is associated with sudden cardiac arrest in stroke patients from ICU: a multicenter retrospective study based on the eICU collaborative research database. Sci Rep 2024; 14:1700. [PMID: 38242966 PMCID: PMC10799080 DOI: 10.1038/s41598-023-51027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/29/2023] [Indexed: 01/21/2024] Open
Abstract
This primary objective of our study was to investigate the relationship between serum calcium levels and the occurrence of sudden cardiac arrest (SCA) in stroke patients. We analyzed the clinical data of 10,423 acute stroke patients admitted to the intensive care unit. The association between serum calcium and SCA following an acute stroke was assessed through multivariate logistic regression. We explored the non-linear connection between serum calcium levels and SCA in stroke patients using a generalized additive model and smooth curve fitting. Our study uncovered that serum calcium serves as an independent risk factor for sudden cardiac arrest in stroke patients. Notably, we observed that the relationship between serum calcium levels upon admission and the occurrence of SCA in stroke patients within the hospital was non-linear. Furthermore, we identified inflection points in serum calcium levels at 8.2 and 10.4 mg/dL. These findings emphasize a non-linear relationship between serum calcium levels and the risk of SCA in stroke patients. Maintaining serum calcium within the range of 8.2-10.4 mg/dL could lead to a significant reduction in the incidence of cardiac arrest among stroke patients.
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Affiliation(s)
- Jianfei Hou
- Department of Functional Examination, The First People's Hospital of Chenzhou, Chenzhou, 423001, China
| | - Zhenhua Huang
- Department of Emergency, Shenzhen Second People's Hospital Shenzhen, Shenzhen, 518035, China
| | - Wenfei Zeng
- Department of Anesthesiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Zhanxing Wu
- Department of Emergency, Shenzhen Second People's Hospital Shenzhen, Shenzhen, 518035, China.
| | - Lingna Zhang
- Department of Functional Examination, The First People's Hospital of Chenzhou, Chenzhou, 423001, China.
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Matte AE, Vossenberg NE, Akers KG, Paxton JH. Intraosseous Vascular Access in Cardiac Arrest: A Systematic Review of the Literature, with Implications for Future Research. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2023. [DOI: 10.1007/s40138-023-00259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Hoehne SN, Hopper K, Epstein SE. Association of point-of-care blood variables obtained from dogs and cats during cardiopulmonary resuscitation and following return of spontaneous circulation with patient outcomes. J Vet Emerg Crit Care (San Antonio) 2023; 33:223-235. [PMID: 36537864 DOI: 10.1111/vec.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventy-two venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO2 (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO2 (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium concentration (0.222 [0.071-0.700], P = 0.010), and chloride concentration (0.805 [0.694-0.933], P = 0.004) were associated with survival to hospital discharge. CONCLUSIONS Biochemical variables such as PvO2 , SBE, and potassium concentration during CPR and pH, potassium, and chloride concentration in the postarrest period may help identify dogs and cats with lower odds for ROSC or survival to hospital discharge following CPR.
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Affiliation(s)
- Sabrina N Hoehne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
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Wang G, Wang Z, Zhu Y, Zhang Z, Li W, Chen X, Mei Y. The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation. World J Emerg Med 2023; 14:354-359. [PMID: 37908806 PMCID: PMC10613802 DOI: 10.5847/wjem.j.1920-8642.2023.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/02/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The ion shift index (ISI) as a prognostic indicator that can show the severity of hypoxic-ischemic injury. We aimed to evaluate the performance of the ISI in predicting unfavorable neurological outcomes at hospital discharge in cardiac arrest (CA) patients following extracorporeal cardiopulmonary resuscitation (ECPR) and to compare its performance to other prognostic predictors. METHODS This was a retrospective observational study including adult CA patients treated with ECPR between January 2018 and December 2022 in a tertiary hospital. Data regarding clinical characteristics and laboratory parameters were collected from medical records. The ISI was determined based on the first available serum electrolyte levels after ECPR. The primary outcome was unfavorable neurological status at hospital discharge, defined as Cerebral Performance Categories 3-5. Comparisons of the characteristics between the two groups were made using the χ2 test for categorical variables and the t-test or non-parametric Mann-Whitney U-test for continuous variables, as appropriate. Correlation analysis was performed using Spearman's rank correlation coefficient. A two-tailed P-value <0.05 was considered statistically significant. RESULTS Among the 122 patients involved, 46 (37.7%) had out-of-hospital CA, and 88 had unfavorable neurological outcomes. The ISI was significantly higher in the unfavorable outcome group than in the favorable outcome group (3.74 [3.15-4.57] vs. 2.69 [2.51-3.07], P<0.001). A higher ISI level was independently related to unfavorable outcome (odds ratio=6.529, 95% confidence interval 2.239-19.044, P=0.001). An ISI level >3.12 predicted unfavorable outcomes with a sensitivity and specificity of 74.6% and 85.2%, respectively (P<0.001). The prognostic performance of ISI (area under the curve [AUC]=0.887) was similar to that of other predictors, such as gray-to-white matter ratio (AUC=0.850, P=0.433) and neuron-specific enolase (AUC=0.925, P=0.394). CONCLUSION ISI may be used as a prognostic biomarker to predict neurological outcomes in CA patients following ECPR.
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Affiliation(s)
- Gannan Wang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhe Wang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yi Zhu
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongman Zhang
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wei Li
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xufeng Chen
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yong Mei
- Department of Emergency, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou 571199, China
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Kirkegaard H, Grejs AM, Gudbjerg S, Duez C, Jeppesen A, Hassager C, Laitio T, Storm C, Taccone FS, Skrifvars MB, Søreide E. Electrolyte profiles with induced hypothermia: A sub study of a clinical trial evaluating the duration of hypothermia after cardiac arrest. Acta Anaesthesiol Scand 2022; 66:615-624. [PMID: 35218019 PMCID: PMC9311071 DOI: 10.1111/aas.14053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/20/2022] [Accepted: 02/16/2022] [Indexed: 11/29/2022]
Abstract
Background Electrolyte disturbances can result from targeted temperature treatment (TTM) in out‐of‐hospital cardiac arrest (OHCA) patients. This study explores electrolyte changes in blood and urine in OHCA patients treated with TTM. Methods This is a sub‐study of the TTH48 trial, with the inclusion of 310 unconscious OHCA patients treated with TTM at 33°C for 24 or 48 h. Over a three‐day period, serum concentrations were obtained on sodium potassium, chloride, ionized calcium, magnesium and phosphate, as were results from a 24‐h diuresis and urine electrolyte concentration and excretion. Changes over time were analysed with a mixed‐model multivariate analysis of variance with repeated measurements. Results On admission, mean ± SD sodium concentration was 138 ± 3.5 mmol/l, which increased slightly but significantly (p < .05) during the first 24 h. Magnesium concentration stayed within the reference interval. Median ionized calcium concentration increased from 1.11 (IQR 1.1–1.2) mmol/l during the first 24 h (p < .05), whereas median phosphate concentration dropped to 1.02 (IQR 0.8–1.2) mmol/l (p < .05) and stayed low. During rewarming, potassium concentrations increased, and magnesium and ionizes calcium concentration decreased (p < .05). Median 24‐h diuresis results on days one and two were 2198 and 2048 ml respectively, and the electrolyte excretion mostly stayed low in the reference interval. Conclusions Electrolytes mostly remained within the reference interval. A temporal change occurred in potassium, magnesium and calcium concentrations with TTM’s different phases. No hypothermia effect on diuresis was detected, and urine excretion of electrolytes mostly stayed low.
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Affiliation(s)
- Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department Aarhus University Hospital Aarhus Denmark
- Research Center for Emergency Medicine, Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Anders M. Grejs
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Simon Gudbjerg
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - Christophe Duez
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
| | - Anni Jeppesen
- Department of Intensive Care Aarhus University Hospital Aarhus Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Timo Laitio
- Division of Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, University of Turku Finland
| | - Christian Storm
- Department of Internal Medicine, Nephrology and Intensive Care Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Fabio Silvio Taccone
- Department of Intensive Care Erasme Hospital, Université Libre de Bruxelles Brussels Belgium
| | - Markus B. Skrifvars
- Department of Anaesthesiology, Intensive Care and Paine Medicine University of Helsinki, Helsinki University Hospital Helsinki Finland
- Department of Emergency Care and Services University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Eldar Søreide
- Critical Care and Anaesthesiology Research Group Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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Vallentin MF, Granfeldt A, Meilandt C, Povlsen AL, Sindberg B, Holmberg MJ, Iversen BN, Mærkedahl R, Mortensen LR, Nyboe R, Vandborg MP, Tarpgaard M, Runge C, Christiansen CF, Dissing TH, Terkelsen CJ, Christensen S, Kirkegaard H, Andersen LW. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2021; 326:2268-2276. [PMID: 34847226 PMCID: PMC8634154 DOI: 10.1001/jama.2021.20929] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE It is unclear whether administration of calcium has a beneficial effect in patients with cardiac arrest. OBJECTIVE To determine whether administration of calcium during out-of-hospital cardiac arrest improves return of spontaneous circulation in adults. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial included 397 adult patients with out-of-hospital cardiac arrest and was conducted in the Central Denmark Region between January 20, 2020, and April 15, 2021. The last 90-day follow-up was on July 15, 2021. INTERVENTIONS The intervention consisted of up to 2 intravenous or intraosseous doses with 5 mmol of calcium chloride (n = 197) or saline (n = 200). The first dose was administered immediately after the first dose of epinephrine. MAIN OUTCOMES AND MEASURES The primary outcome was sustained return of spontaneous circulation. The secondary outcomes included survival and a favorable neurological outcome (modified Rankin Scale score of 0-3) at 30 days and 90 days. RESULTS Based on a planned interim analysis of 383 patients, the steering committee stopped the trial early due to concerns about harm in the calcium group. Of 397 adult patients randomized, 391 were included in the analyses (193 in the calcium group and 198 in the saline group; mean age, 68 [SD, 14] years; 114 [29%] were female). There was no loss to follow-up. There were 37 patients (19%) in the calcium group who had sustained return of spontaneous circulation compared with 53 patients (27%) in the saline group (risk ratio, 0.72 [95% CI, 0.49 to 1.03]; risk difference, -7.6% [95% CI, -16% to 0.8%]; P = .09). At 30 days, 10 patients (5.2%) in the calcium group and 18 patients (9.1%) in the saline group were alive (risk ratio, 0.57 [95% CI, 0.27 to 1.18]; risk difference, -3.9% [95% CI, -9.4% to 1.3%]; P = .17). A favorable neurological outcome at 30 days was observed in 7 patients (3.6%) in the calcium group and in 15 patients (7.6%) in the saline group (risk ratio, 0.48 [95% CI, 0.20 to 1.12]; risk difference, -4.0% [95% CI, -8.9% to 0.7%]; P = .12). Among the patients with calcium values measured who had return of spontaneous circulation, 26 (74%) in the calcium group and 1 (2%) in the saline group had hypercalcemia. CONCLUSIONS AND RELEVANCE Among adults with out-of-hospital cardiac arrest, treatment with intravenous or intraosseous calcium compared with saline did not significantly improve sustained return of spontaneous circulation. These results do not support the administration of calcium during out-of-hospital cardiac arrest in adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04153435.
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Affiliation(s)
| | - Asger Granfeldt
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Meilandt
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
| | | | - Birthe Sindberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias J. Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
| | - Bo Nees Iversen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Mærkedahl
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Herning Regional Hospital, Herning, Denmark
| | - Lone Riis Mortensen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark
| | - Rasmus Nyboe
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Horsens Regional Hospital, Horsens, Denmark
| | - Mads Partridge Vandborg
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Denmark
| | - Maren Tarpgaard
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Herning Regional Hospital, Herning, Denmark
| | - Charlotte Runge
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Thomas H. Dissing
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Lars W. Andersen
- Prehospital Emergency Medical Services, Central Denmark Region, Aarhus
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
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Kim SJ, Kim HS, Hwang SO, Jung WJ, Roh YI, Cha KC, Shin SD, Song KJ. Ionized calcium level at emergency department arrival is associated with return of spontaneous circulation in out-of-hospital cardiac arrest. PLoS One 2020; 15:e0240420. [PMID: 33045006 PMCID: PMC7549779 DOI: 10.1371/journal.pone.0240420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022] Open
Abstract
Background Calcium level is associated with sudden cardiac death based on several cohort studies. However, there is limited evidence on the association between ionized calcium, active form of calcium, and resuscitation outcome. This study aimed to evaluate the potential role of ionized calcium in predicting resuscitation outcome in patients with out-of-hospital cardiac arrest. Methods We analyzed the Korean Cardiac Arrest Research Consortium data (KoCARC) registry, a web-based multicenter registry that included 65 participating hospitals throughout the Republic of Korea. The patients with out-of-hospital cardiac arrest over 19 years old and acquired laboratory data including calcium, ionized calcium, potassium, phosphorus, creatinine, albumin at emergency department (ED) arrival were included. The primary outcome was successful rate of return of spontaneous circulation (ROSC) and the secondary outcomes were survival hospital discharge and favorable neurological outcome (cerebral performance category 1 or 2) at hospital discharge. Results Eight-hundred and eighty-three patients were enrolled in the final analysis and 448 cases (54%) had ROSC. In multivariable logistic regression analysis, ionized calcium level was associated with ROSC (odds ratio, 1.77; 95% CI1.28–2.45; p = 0.001) even though calcium level was not associated with ROSC (odds ratio, 0.87; 95% CI 0.70–1.08; p = 0.199). However, ionized calcium level was not associated with survival discharge (odds ratio, 0.99; 95% CI 0.72–1.36; p = 0.948) or favorable neurologic outcome (odds ratio, 0.45; 95% CI 0.03–6.55, p = 0.560). Conclusion A high ionized calcium level measured during cardiopulmonary resuscitation was associated with an increased likelihood of ROSC.
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Affiliation(s)
- Sun Ju Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hye Sim Kim
- Center of Biomedical Data Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Woo Jin Jung
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Young Il Roh
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- * E-mail:
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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9
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Ion shift index as a promising prognostic indicator in adult patients resuscitated from cardiac arrest. Resuscitation 2019; 137:116-123. [DOI: 10.1016/j.resuscitation.2019.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 11/21/2022]
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When extracorporeal CPR fails-fatal ionized hypocalcemia during cardiac arrest. Am J Emerg Med 2016; 34:2251.e1-2251.e2. [PMID: 27113129 DOI: 10.1016/j.ajem.2016.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/26/2016] [Indexed: 11/21/2022] Open
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Bellomo R, Märtensson J, Eastwood GM. Metabolic and electrolyte disturbance after cardiac arrest: How to deal with it. Best Pract Res Clin Anaesthesiol 2015; 29:471-84. [DOI: 10.1016/j.bpa.2015.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/02/2015] [Accepted: 10/05/2015] [Indexed: 12/15/2022]
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Hopper K, Borchers A, Epstein SE. Acid base, electrolyte, glucose, and lactate values during cardiopulmonary resuscitation in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2014; 24:208-14. [PMID: 24739035 DOI: 10.1111/vec.12151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/21/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report acid base, electrolyte, glucose, and lactate values collected during or immediately after cardiopulmonary resuscitation (CPR) in dogs and cats. DESIGN Retrospective study. SETTING University Teaching Hospital. ANIMALS Thirty-two dogs and 10 cats. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Blood gas, electrolyte, glucose, and lactate values measured during CPR or within 5 minutes of return of spontaneous circulation (ROSC) were retrospectively evaluated. The time of blood collection with respect to the occurrence of cardiopulmonary arrest (CPA), the initiation of CPR or ROSC was noted. Forty-two venous blood samples were analyzed, 24 collected during CPR and 18 samples were collected within 5 minutes of ROSC. Metabolic acidosis and hyperlactatemia were evident in all samples in the study while an increased PvCO2 occurred in 88% of samples collected during CPR and in 61% of samples collected following ROSC. Hyperkalemia occurred in 65% of all cases, decreased ionized calcium was evident in 18%, hypoglycemia was evident in 21% while hyperglycemia was evident in 62%. There was no significant difference in any parameter evaluated between dogs and cats during CPR. There was no significant difference of any variable measured during the first 15 minutes of CPA versus those measured more than 15 minutes following CPA. When the values measured during the first 5 minutes of ROSC were compared to those measured during CPR, the pH and PvO2 were significantly lower in the CPR group. CONCLUSIONS Biochemical abnormalities including metabolic acidosis, hyperkalemia, ionized hypocalcemia, hypoglycemia, and hyperglycemia can be identified during CPR and immediately following ROSC. The therapeutic and prognostic relevance of these changes are yet to be defined and may prove to be useful to guide patient management in the future.
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Affiliation(s)
- Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis, Davis, CA, 95616
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Rando K, Vázquez M, Cerviño G, Zunini G. Hypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hipocalcemia, hiperpotasemia y hemorragia masiva en el trasplante de hígado. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rando K, Vázquez M, Cerviño G, Zunini G. Hypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442030-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
PURPOSE OF REVIEW Recent recognition of the importance of postresuscitation care has stimulated interest and new reports concerning therapies for postcardiac arrest myocardial dysfunction. Such cardiac dysfunction after successful resuscitation can be severe and even lethal; however, it is also transient emphasizing the importance of early supportive therapies. RECENT FINDINGS The most important strategies for dealing with postresuscitation myocardial dysfunction include a community-formalized effort by individual communities to shorten the time from arrest to restoration of spontaneous circulation, use of therapeutic hypothermia for myocardial preservation, not just cerebral, and early coronary angiography and intervention for all survivors with a high suspicion of a cardiac cause for their arrest. Exciting specific therapies targeted for one or another of the ischemia/reperfusion myocardial injuries associated with cardiac arrest include manipulation of the nitric oxide production in the myocardium, treatment of myocardial microcirculatory dysfunction post resuscitation, inhibition of Na+/H+ exchange, and treatment of calcium flux abnormalities. SUMMARY Every community should be striving to provide more timely restoration of pulse and circulation, whereas every medical center receiving patients resuscitated from out-of-hospital cardiac arrest should be providing therapeutic hypothermia for both central nervous system and myocardial preservation. The ability and commitment to provide '24/7' early coronary angiography and percutaneous intervention for all resuscitated victims of sudden cardiac death with a likely cardiac cause for their arrest is also key.
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Abstract
BACKGROUND This study was designed to evaluate serum potassium level variation in a porcine model of hemorrhagic shock (HS). METHODS Eight pigs were studied in a controlled hemorrhage model of HS. Blood withdrawal began at a 50 mL/min to 70 mL/min rate, adjusted to reach a mean arterial pressure (MAP) level of 60 mm Hg in 10 minutes. When MAP reached 60 mm Hg, the blood withdrawal rate was adjusted to maintain a MAP decrease rate of 10 mm Hg every 2 minutes to 4 minutes. Arterial and mixed venous blood samples were collected at MAP levels of 60 mm Hg, 50 mm Hg, 40 mm Hg, 30 mm Hg, 20 mm Hg, and 10 mm Hg and analyzed for oxygen saturation, Po2, Pco2, potassium, lactate, bicarbonate, hemoglobin, pH, and standard base excess. RESULTS Significant increase in serum potassium occurred early in all animals. The rate of rise in serum potassium and its levels accompanied the hemodynamic deterioration. Hyperkalemia (K >5 mmol/L) incidence was 12.5% at 60 mm Hg and 50 mm Hg, 62.5% at 40 mm Hg, 87.5% at 30 mm Hg, and 100% at 20 mm Hg. Strong correlations were found between potassium levels and lactate (R = 0.82), SvO2 (R = 0.87), DeltapH (R = 0.83), and DeltaPco2 (R = 0.82). CONCLUSIONS Serum potassium increase accompanies the onset of HS. The rise in serum potassium was directly related to the hemodynamic deterioration of HS and strongly correlated with markers of tissue hypoxia.
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The units of measurement of the ventricular stroke work: a review study. J Clin Monit Comput 2010; 24:213-7. [PMID: 20473780 DOI: 10.1007/s10877-010-9234-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 04/26/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND The ventricular stroke work refers to the work done by the left or right ventricle to eject the volume of blood during one cardiac cycle, called stroke volume. Sarnoff and Berglund were one of the first to calculate the stroke work from the pressure volume diagram in 1954. However, they published a wrong unit of measurement for the stroke work, namely gram meter. METHODS AND RESULTS The present work reviewed 779 scientific publications between May 1954 and January 2010 which used the left or right ventricular stroke work as a variable. Interestingly, the majority (87.2%) of scientific papers since 1954 have either copied this (or a similar) wrong unit of measurement or have invented another one. Only 12.8% of the publications gave a correct unit. CONCLUSION The present search in scientific literature demonstrates that the haemodynamic variable ventricular stroke work, which is used daily by thousands of medical doctors and scientists, was specified in an incorrect manner for 56 years in the majority of scientific papers. A correct unit of measurement, of course, is an imperative condition when comparing scientific papers. The aim of this publication is the elimination of incorrect units of measurement of the ventricular stroke work variable in all future scientific papers. Moreover, the present work facilitates the interpretation of at least some of the studies containing the ventricular stroke work variable published up to now.
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