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Freedman BL, Maher TR, Tracey M, Santangeli P, d'Avila A. Procedural Adaptations to Avoid Haemodynamic Instability During Catheter Ablation of Scar-related Ventricular Tachycardia. Arrhythm Electrophysiol Rev 2023; 12:e20. [PMID: 37465104 PMCID: PMC10350657 DOI: 10.15420/aer.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 07/20/2023] Open
Abstract
Classically, catheter ablation for scar-related ventricular tachycardia (VT) relied upon activation and entrainment mapping of induced VT. Advances in post-MI therapies have led to VTs that are faster and haemodynamically less stable, because of more heterogeneous myocardial fibrosis patterns. The PAINESD score is one means of identifying patients at highest risk for haemodynamic decompensation during attempted VT induction, who may, therefore, benefit from alternative ablation strategies. One strategy is to use temporary mechanical circulatory support, although this warrants formal assessment of cost-effectiveness. A second strategy is to minimise or avoid VT induction altogether by employing a family of 'substrate'-based approaches aimed at identifying VT isthmuses during sinus or paced rhythm. Substrate mapping techniques are diverse, and focus on the timing, morphology and amplitude of local ventricular electrograms - sometimes aided by advanced non-invasive cardiac imaging modalities. In this review, the evolution of VT ablation over time is discussed, with an emphasis on procedural adaptations to the challenge of haemodynamic instability.
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Affiliation(s)
- Benjamin L Freedman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | - Timothy R Maher
- Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
| | | | - Pasquale Santangeli
- Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, US
| | - Andre d'Avila
- Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
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Huppert EL, Parnia S. Cerebral oximetry: a developing tool for monitoring cerebral oxygenation during cardiopulmonary resuscitation. Ann N Y Acad Sci 2021; 1509:12-22. [PMID: 34780070 DOI: 10.1111/nyas.14706] [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: 05/04/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
Despite improvements in cardiopulmonary resuscitation (CPR), survival and neurologic recovery after cardiac arrest remain very poor because of the impact of severe ischemia and subsequent reperfusion injury. As the likelihood of survival and favorable neurologic outcome decreases with increasing severity of ischemia during CPR, developing methods to measure the magnitude of ischemia during resuscitation, particularly cerebral ischemia, is critical for improving overall outcomes. Cerebral oximetry, which measures regional cerebral oxygen saturation (rSO2 ) by near-infrared spectroscopy, has emerged as a potentially beneficial marker of cerebral ischemia during CPR. In numerous preclinical and clinical studies, higher rSO2 during CPR has been associated with improved cardiac arrest survival and neurologic outcome. In this narrative review, we summarize the scientific rationale and validation of cerebral oximetry across populations and pathophysiologic states, discuss the evidence surrounding its use to predict return of spontaneous circulation, rearrest, and neurologic outcome, and provide suggestions for incorporation of cerebral oximetry into CPR practice.
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Affiliation(s)
- Elise L Huppert
- Critical Care and Resuscitation Research Center, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York
| | - Sam Parnia
- Critical Care and Resuscitation Research Center, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Langone Health, New York, New York
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Impact of Postshock Transcutaneous Pacing on Chest Compression Quality during Resuscitation: A Simulation-Based Pilot Study. Emerg Med Int 2021; 2021:5584632. [PMID: 33981460 PMCID: PMC8088345 DOI: 10.1155/2021/5584632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Successful defibrillation is commonly followed by a transient nonperfusing state. To provide perfusion in this stagnant phase, chest compressions are recommended irrespective of arrhythmia termination. Implantable cardioverters-defibrillators (ICD) used immediately after delivery of the shock are capable of pacing the heart, and this feature is commonly activated in these devices. Potential utility of external, transcutaneous postshock pacing in patients with SCA in shockable rhythms has not been determined. This study aimed at presenting an impact of a short-term external postshock pacing (ePSP) on a quality of chest compressions (CC) without compromising them. Methods The study was designed as a high-fidelity simulation study. Twenty triple-paramedic teams were invited. Participants were asked to take part in a 10-minute adult cardiac arrest scenario with ventricular fibrillation. In the first simulation, paramedics had to resume compressions after each shock (control group). In the second, simultaneous with compressions, one of the rescuers started transcutaneous pacing (TCP) with a current output of 200 mA and a pacer rate of 80 ppm. TCP was finished after 30 seconds (experimental group). The primary outcomes were chest compression fraction (CCF), mean depth and rate of compressions, percent of fully recoiled compressions, and percent of compressions of correct depth and their rate. Results In both experimental and control group, CCF, mean depth, and rate were similar (84.65 ± 3.67 vs. 85.45 ± 4.95, p=0.54; 55.75 ± 3.40 vs. 55.25 ± 2.73, p=0.63; 122.70 ± 4.92 vs. 120.80 ± 6.00, p=0.25, respectively). In turn, percent of CC performed in correct depth, rate, and recoil was unsatisfactory in both groups (51.00 ± 17.40 vs. 52.60 ± 18.72, p=0.76; 122.70 ± 4.92 vs. 120.80 ± 6.00, p=0.25, respectively). Small differences were not statistically significant. Moreover, appropriate hand-positioning was observed more frequently in the control group, and this was the only significant difference (95.60 ± 5.32 vs. 99.30 ± 1.59, p=0.006). Conclusion This difference was statistically significant (p < 0.01). Introducing an ePSP does not influence relevantly the quality of CC.
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Veraar CM, Rinösl H, Kühn K, Skhirtladze-Dworschak K, Felli A, Mouhieddine M, Menger J, Pataraia E, Ankersmit HJ, Dworschak M. Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:426. [PMID: 31888721 PMCID: PMC6937980 DOI: 10.1186/s13054-019-2671-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Systemic blood flow in patients on extracorporeal assist devices is frequently not or only minimally pulsatile. Loss of pulsatile brain perfusion, however, has been implicated in neurological complications. Furthermore, the adverse effects of absent pulsatility on the cerebral microcirculation are modulated similarly as CO2 vasoreactivity in resistance vessels. During support with an extracorporeal assist device swings in arterial carbon dioxide partial pressures (PaCO2) that determine cerebral oxygen delivery are not uncommon-especially when CO2 is eliminated by the respirator as well as via the gas exchanger of an extracorporeal membrane oxygenation machine. We, therefore, investigated whether non-pulsatile flow affects cerebrovascular CO2 reactivity (CVR) and regional brain oxygenation (rSO2). METHODS In this prospective, single-centre case-control trial, we studied 32 patients undergoing elective cardiac surgery. Blood flow velocity in the middle cerebral artery (MCAv) as well as rSO2 was determined during step changes of PaCO2 between 30, 40, and 50 mmHg. Measurements were conducted on cardiopulmonary bypass during non-pulsatile and postoperatively under pulsatile blood flow at comparable test conditions. Corresponding changes of CVR and concomitant rSO2 alterations were determined for each flow mode. Each patient served as her own control. RESULTS MCAv was generally lower during hypocapnia than during normocapnia and hypercapnia (p < 0.0001). However, the MCAv/PaCO2 slope during non-pulsatile flow was 14.4 cm/s/mmHg [CI 11.8-16.9] and 10.4 cm/s/mmHg [CI 7.9-13.0] after return of pulsatility (p = 0.03). During hypocapnia, non-pulsatile CVR (4.3 ± 1.7%/mmHg) was higher than pulsatile CVR (3.1 ± 1.3%/mmHg, p = 0.01). Independent of the flow mode, we observed a decline in rSO2 during hypocapnia and a corresponding rise during hypercapnia (p < 0.0001). However, the relationship between ΔrSO2 and ΔMCAv was less pronounced during non-pulsatile flow. CONCLUSIONS Non-pulsatile perfusion is associated with enhanced cerebrovascular CVR resulting in greater relative decreases of cerebral blood flow during hypocapnia. Heterogenic microvascular perfusion may account for the attenuated ΔrSO2/ΔMCAv slope. Potential hazards related to this altered regulation of cerebral perfusion still need to be assessed. TRIAL REGISTRATION The study was retrospectively registered on October 30, 2018, with Clinical Trial.gov (NCT03732651).
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Affiliation(s)
- Cecilia Maria Veraar
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Harald Rinösl
- Department of Anaesthesia and Intensive Care Medicine, LKH Feldkirch, Feldkirch, Austria
| | - Karina Kühn
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Klinikum Traunstein, Traunstein, Germany
| | - Keso Skhirtladze-Dworschak
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alessia Felli
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mohamed Mouhieddine
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Menger
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ekaterina Pataraia
- Department of Neurology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Division of Thoracic Surgery, Department of Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin Dworschak
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Regional Cerebral Saturation Monitoring During Cardiopulmonary Resuscitation-The Magic Crystal Ball That Allows Peeking Into the Future? Crit Care Med 2018; 44:1786-8. [PMID: 27525999 DOI: 10.1097/ccm.0000000000001794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schnaubelt S, Sulzgruber P, Menger J, Skhirtladze-Dworschak K, Sterz F, Dworschak M. Regional cerebral oxygen saturation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation and favourable neurological outcome - A review of the current literature. Resuscitation 2018; 125:39-47. [PMID: 29410191 DOI: 10.1016/j.resuscitation.2018.01.028] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/04/2018] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Regional cerebral oxygen saturation (rSO2) can be measured non-invasively even at no- or low-flow states. It thus allows assessment of brain oxygenation during CPR. Certain rSO2 values had been associated with return of spontaneous circulation (ROSC) and neurological outcome in the past. Clear-cut thresholds for the prediction of beneficial outcome, however, are still lacking. METHODS We conducted a database search to extract all available investigations on rSO2 measurement during CPR. Mean, median, and ΔrSO2 values were either taken from the studies or calculated. Thresholds for the outcome "ROSC" and "neurological outcome" were sought. RESULTS We retrieved 26 publications for the final review. The averaged mean rSO2 for patients achieving ROSC was 41 ± 12% vs. 30 ± 12% for non-ROSC (p = .009). ROSC was not observed when mean rSO2 remained <26%. In ROSC patients, ΔrSO2 was 22 ± 16% vs. 7 ± 10% in non-ROSC patients (p = .009). A rSO2 threshold of 36% predicted ROSC with a sensitivity of 67% and specificity of 69% while ΔrSO2 of 7% showed a sensitivity of 100% and a specificity of 86% (AUC = 0.733 and 0.893, respectively). Mean rSO2 of 47 ± 11% was associated with favourable and 38 ± 12% with poor neurological outcome. There was, however, a great overlap between groups due to scarce data. CONCLUSION Higher rSO2 consistently correlated with increased rates of ROSC. The discriminatory power of rSO2 to prognosticate favourable neurological outcome remains unclear. Measuring rSO2 during CPR could potentially facilitate clinical decision-making.
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Affiliation(s)
- S Schnaubelt
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria; Department of Emergency Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - P Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Austria
| | - J Menger
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - K Skhirtladze-Dworschak
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - F Sterz
- Department of Emergency Medicine, Medical University of Vienna, Vienna General Hospital, Austria
| | - M Dworschak
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna General Hospital, Austria.
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Kodani T, Mine T, Kishima H, Masuyama T. The Effects of Shock from Defibrillation Threshold Testing on Cardiac Systolic and Diastolic Function. Pacing Clin Electrophysiol 2016; 39:999-1005. [PMID: 27380898 DOI: 10.1111/pace.12915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 05/15/2016] [Accepted: 06/17/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inappropriate implantable cardioverter defibrillator (ICD) shocks are associated with increased overall mortality. However, it remains unclear whether shocks from defibrillation threshold (DFT) testing directly impair cardiac function. METHODS DFT testing was performed in 34 patients who underwent ICD/cardiac resynchronization therapy with a defibrillator implantation/generator exchange. Heart rate and cardiac function, including left ventricular (LV) systolic pressure, LV end-diastolic pressure, peak positive and negative dp/dt ( + dp/dt and -dp/dt, respectively) of LV pressure, and the tau index, were assessed with a Mikro-Cath™ diagnostic pressure catheter (CD Leycom, Zoetermeer, the Netherlands). These parameters were measured before and 1 minute, 3 minutes, 5 minutes, 10 minutes, and 15 minutes after DFT testing. RESULTS Peak positive dp/dt increased over baseline at each interval (976 ± 229 mm Hg/s vs 1,039 ± 258, 1,049 ± 245, 1,042 ± 247, 1,037 ± 259, and 1,034 ± 254 mm Hg/s, respectively; P < 0.01). Furthermore, peak negative dp/dt (-1,140 ± 397 mm Hg/s vs -1,185 ± 447, 1,193 ± 435, -1,195 ± 434, -1,189 ± 449, and -1,186 ± 459 mm Hg/s, respectively; P < 0.01) and the tau index (65.1 ± 18.5 vs 62.5 ± 16.8*, 62.4 ± 15.9(**) , 63.0 ± 16.8*, and 62.8 ± 18.7*, respectively; *P < 0.05, (**) P < 0.01) decreased compared to those at baseline at each interval. CONCLUSION Shock after DFT testing improved LV systolic and diastolic function immediately, especially in patients with preserved LV ejection fraction.
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Affiliation(s)
- Takeshi Kodani
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takanao Mine
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Hideyuki Kishima
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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BAYSA SHERRIEJOYA, OLEN MELISSA, KANTER RONALDJ, FISHBERGER STEVENB. Defibrillation Testing Strategies of Pediatric and Adult Congenital Electrophysiologists during ICD Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:843-7. [DOI: 10.1111/pace.12896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/11/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SHERRIE JOY A. BAYSA
- Nicklaus Children's Hospital Heart Program; Miami Children's Health System; Miami Florida
| | - MELISSA OLEN
- Nicklaus Children's Hospital Heart Program; Miami Children's Health System; Miami Florida
| | - RONALD J. KANTER
- Nicklaus Children's Hospital Heart Program; Miami Children's Health System; Miami Florida
| | - STEVEN B. FISHBERGER
- Nicklaus Children's Hospital Heart Program; Miami Children's Health System; Miami Florida
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Near-infrared spectroscopy during cardiopulmonary resuscitation and after restoration of spontaneous circulation. Curr Opin Crit Care 2016; 22:191-8. [DOI: 10.1097/mcc.0000000000000301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arnson Y, Suleiman M, Glikson M, Sela R, Geist M, Amit G, Schliamser JE, Goldenberg I, Ben-Zvi S, Orvin K, Rosenheck S, Adam Freedberg N, Strasberg B, Haim M. Role of defibrillation threshold testing during implantable cardioverter-defibrillator placement: Data from the Israeli ICD Registry. Heart Rhythm 2014; 11:814-21. [DOI: 10.1016/j.hrthm.2014.01.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Indexed: 10/25/2022]
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Skhirtladze-Dworschak K, Dworschak M. Cerebral oximetry and cardiac arrest. Semin Cardiothorac Vasc Anesth 2013; 17:269-75. [PMID: 23782549 DOI: 10.1177/1089253213492861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral oximetry is a Food and Drug Administration-approved technology that allows monitoring of brain oxygen saturation in accessible superficial brain cortex regions, which are amongst the most vulnerable in regard to ischemic or hypoxic injury. Since most oxygen in the area of interest is located in the venous compartment, the determined regional brain oxygen saturation approximately reflects the local balance between oxygen delivery and oxygen consumption. Major systemic alterations in blood oxygen content and oxygen delivery will be accompanied by corresponding changes in regional brain saturation. This systematic review, which is based on a Medline search, focuses on the characteristic changes in regional cerebral oxygen saturation that occur, when global oxygen supply to the brain ceases. It further highlights the potential application of cerebral oximetry in the management of cardiac arrest victims, the predictability of clinical outcome after global cerebral ischemia, and it also indicates possible potentials for the management of cerebral reperfusion after having instituted return of spontaneous circulation.
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Dworschak M. Is Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest Superior Compared With Conventional Resuscitation?*. Crit Care Med 2013; 41:1365-6. [DOI: 10.1097/ccm.0b013e31828044c0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toh N, Nishii N, Nakamura K, Tada T, Oe H, Nagase S, Kohno K, Morita H, Kusano KF, Ito H. Cardiac dysfunction and prolonged hemodynamic deterioration after implantable cardioverter-defibrillator shock in patients with systolic heart failure. Circ Arrhythm Electrophysiol 2012; 5:898-905. [PMID: 22837155 DOI: 10.1161/circep.111.970285] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We investigated the acute effects of implantable cardioverter-defibrillator shock on myocardium, cardiac function, and hemodynamics in relation to left ventricular systolic function. METHODS AND RESULTS We studied 50 patients who underwent implantable cardioverter-defibrillator implantation and defibrillation threshold (DFT) testing: 25 patients with left ventricular ejection fraction (LVEF) ≥ 45% and 25 patients with LVEF <45%. We measured cardiac biomarkers (creatine kinase, creatine kinase-MB, myoglobin, cardiac troponin T and I, and N-terminal probrain natriuretic peptide). Left ventricular relaxation was assessed by global longitudinal strain rate during the isovolumetric relaxation period using speckle-tracking echocardiography. Blood sampling and echocardiography were performed before, immediately after, and 5 minutes and 4 hours after DFT testing. Mean arterial pressure was measured directly during DFT testing. Cardiac biomarkers showed no significant changes in either group. LVEF was decreased until 5 minutes after DFT testing and had recovered to the baseline at 4 hours in the group with reduced LVEF (P<0.001), whereas LVEF reduction was not observed in the group with preserved LVEF (P=0.637). Global isovolumetric relaxation period was decreased until 5 minutes after DFT testing and had recovered to the baseline at 4 hours in both groups (preserved LVEF: 0.39 ± 0.14 versus 0.23 ± 0.13* versus 0.23 ± 0.13* versus 0.40 ± 0.13 s(-1), *P<0.001 versus baseline; reduced LVEF: 0.15 ± 0.05 versus 0.08 ± 0.04† versus 0.09 ± 0.04† versus 0.15 ± 0.05 s(-1), †P<0.001 versus baseline, repeated-measures ANOVA). Time to recovery of mean arterial pressure to the baseline was prolonged in the group with reduced LVEF (P<0.001). CONCLUSIONS Implantable cardioverter-defibrillator shock transiently impairs cardiac function and hemodynamics especially in patients with systolic dysfunction, although significant tissue injury is not observed.
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Affiliation(s)
- Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
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Pang B, Everest E, McGavigan AD. Utility of atrial temporary pacing as an acute treatment for bradyarrhythmias and tachyarrhythmias in the intensive care setting with preservation of atrioventricular synchrony. Intern Med J 2012; 42:581-5. [DOI: 10.1111/j.1445-5994.2012.02767.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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