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Kim J, Won D, Kim TH, Kim CY, Ko SH. Rapid prototyping and facile customization of conductive hydrogel bioelectronics based on all laser process. Biosens Bioelectron 2024; 258:116327. [PMID: 38703496 DOI: 10.1016/j.bios.2024.116327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Proper customization in size and shape is essential in implantable bioelectronics for stable bio-signal recording. Over the past decades, many researchers have heavily relied on conventional photolithography processes to fabricate implantable bioelectronics. Therefore, they could not avoid the critical limitation of high cost and complex processing steps to optimize bioelectronic devices for target organs with various sizes and shapes. Here, we propose rapid prototyping using all laser processes to fabricate customized bioelectronics. PEDOT:PSS is selectively irradiated by an ultraviolet (UV) pulse laser to form wet-stable conductive hydrogels that can softly interact with biological tissues (50 μm line width). The encapsulation layer is selectively patterned using the same laser source by UV-curing polymer networks (110 μm line width). For high stretchability (over 100%), mesh structures are made by the selective laser cutting process. Our rapid prototyping strategy minimizes the use of high-cost equipment, using only a single UV laser source to process the electrodes, encapsulation, and substrates that constitute bioelectronics without a photomask, enabling the prototyping stretchable microelectrode array with an area of 1 cm2 less than 10 min. We fabricated an optimized stretchable microelectrode array with low impedances (∼1.1 kΩ at 1 kHz) that can effectively record rat's cardiac signals with various health states.
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Affiliation(s)
- Jin Kim
- Department of Physiology, College of Medicine, Soonchunhyang University, Cheonan, 31151, Republic of Korea
| | - Daeyeon Won
- Applied Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Tae Hyun Kim
- Applied Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea; School of Mechanical Engineering, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - C-Yoon Kim
- College of Veterinary Medicine, Konkuk University, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.
| | - Seung Hwan Ko
- Applied Nano and Thermal Science Lab, Department of Mechanical Engineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea; Institute of Engineering Research / Institute of Advanced Machinery and Design (SNU-IAMD), Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea; Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Kjeld T, Krag TO, Brenøe A, Møller AM, Arendrup HC, Højberg J, Fuglø D, Hancke S, Tolbod LP, Gormsen LC, Vissing J, Hansen EG. Hemoglobin concentration and blood shift during dry static apnea in elite breath hold divers. Front Physiol 2024; 15:1305171. [PMID: 38745836 PMCID: PMC11092981 DOI: 10.3389/fphys.2024.1305171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/23/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Elite breath-hold divers (BHD) enduring apneas of more than 5 min are characterized by tolerance to arterial blood oxygen levels of 4.3 kPa and low oxygen-consumption in their hearts and skeletal muscles, similar to adult seals. Adult seals possess an adaptive higher hemoglobin-concentration and Bohr effect than pups, and when sedated, adult seals demonstrate a blood shift from the spleen towards the brain, lungs, and heart during apnea. We hypothesized these observations to be similar in human BHD. Therefore, we measured hemoglobin- and 2,3-biphosphoglycerate-concentrations in BHD (n = 11) and matched controls (n = 11) at rest, while myocardial mass, spleen and lower extremity volumes were assessed at rest and during apnea in BHD. Methods and results After 4 min of apnea, left ventricular myocardial mass (LVMM) determined by 15O-H2O-PET/CT (n = 6) and cardiac MRI (n = 6), was unaltered compared to rest. During maximum apnea (∼6 min), lower extremity volume assessed by DXA-scan revealed a ∼268 mL decrease, and spleen volume, assessed by ultrasonography, decreased ∼102 mL. Compared to age, BMI and VO2max matched controls (n = 11), BHD had similar spleen sizes and 2,3- biphosphoglycerate-concentrations, but higher total hemoglobin-concentrations. Conclusion Our results indicate: 1) Apnea training in BHD may increase hemoglobin concentration as an oxygen conserving adaptation similar to adult diving mammals. 2) The blood shift during dry apnea in BHD is 162% more from the lower extremities than from the spleen. 3) In contrast to the previous theory of the blood shift demonstrated in sedated adult seals, blood shift is not towards the heart during dry apnea in humans.
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Affiliation(s)
- Thomas Kjeld
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas O. Krag
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Brenøe
- Department of Clinical Medicine, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ann Merete Møller
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jens Højberg
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dan Fuglø
- Department of Nuclear Medicine, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Hancke
- Department of Clinical Medicine, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Egon Godthaab Hansen
- Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Coneybeare D, Gordon M. Right Ventricular Dilation in Cardiac Arrest May Have Complicated Implications: A Case Report. Cureus 2022; 14:e23608. [PMID: 35505716 PMCID: PMC9053377 DOI: 10.7759/cureus.23608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Right ventricular (RV) dilation has been observed in patients in cardiac arrest. Historically, this phenomenon is almost always attributed to massive pulmonary embolism. However, recent advancements have revealed that there are many other causes of RV dilation in cardiac arrest. In this case report, we present the case of an elderly woman who was found in cardiac arrest with an initial normal left ventricle to RV ratio with subsequent development of RV dilation in the midst of resuscitation without changes to other hemodynamic parameters. This case further bolsters the complex nature of cardiac physiology in cardiac arrest and the need for further investigation.
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Jamal SM, Fruitman DS, Lichtenstein KM, Freed DH, Yanchar NL. Inadvertent cannulation of the azygos vein during eCPR. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Flower L, Olusanya O, Madhivathanan PR. The use of critical care echocardiography in peri-arrest and cardiac arrest scenarios: Pros, cons and what the future holds. J Intensive Care Soc 2021; 22:230-240. [PMID: 34422106 PMCID: PMC8373287 DOI: 10.1177/1751143720936998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Echocardiography is being increasingly deployed as a diagnostic and monitoring tool in the critically ill. This rise in popularity has led to its recommendation as a core competence in intensive care, with several training routes available. In the peri-arrest and cardiac arrest population, point of care focused echocardiography has the potential to transform patient care and improve outcomes. Be it via diagnosis of shock aetiology and reversibility or assessing response to treatment and prognostication. This narrative review discusses current and future applications of echocardiography in this patient group and provides a structure with which one can approach such patients.
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Affiliation(s)
- Luke Flower
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, UK
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Pradeep R Madhivathanan
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. [Adult advanced life support]. Notf Rett Med 2021; 24:406-446. [PMID: 34121923 PMCID: PMC8185697 DOI: 10.1007/s10049-021-00893-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
These European Resuscitation Council Advanced Life Support guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Köln, Köln, Deutschland
| | - Pierre Carli
- SAMU de Paris, Center Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, Frankreich
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Großbritannien
- Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Charles D. Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, Großbritannien
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, Großbritannien
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Schweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Schweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Österreich
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Pordenone, Italien
| | - Gavin D. Perkins
- Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, Großbritannien
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rom, Italien
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rom, Italien
| | - Jerry P. Nolan
- Warwick Medical School, Coventry, Großbritannien, Consultant in Anaesthesia and Intensive Care Medicine Royal United Hospital, University of Warwick, Bath, Großbritannien
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Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, Lott C, Olasveengen T, Paal P, Pellis T, Perkins GD, Sandroni C, Nolan JP. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161:115-151. [PMID: 33773825 DOI: 10.1016/j.resuscitation.2021.02.010] [Citation(s) in RCA: 430] [Impact Index Per Article: 143.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Advanced Life Support guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the prevention of and ALS treatments for both in-hospital cardiac arrest and out-of-hospital cardiac arrest.
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Affiliation(s)
- Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Pierre Carli
- SAMU de Paris, Centre Hospitalier Universitaire Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, and Université Paris Descartes, Paris, France
| | - Keith Couper
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry,UK
| | - Charles D Deakin
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne,UK
| | - Therese Djärv
- Dept of Acute and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden, Department of Medicine Solna, Karolinska Institutet,Stockholm, Sweden
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet Mainz, Germany
| | - Theresa Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Peter Paal
- Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Tommaso Pellis
- Department of Anaesthesia and Intensive Care, Azienda Sanitaria Friuli Occidentale, Italy
| | - Gavin D Perkins
- University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL; Royal United Hospital, Bath, UK
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Cardiac hypoxic resistance and decreasing lactate during maximum apnea in elite breath hold divers. Sci Rep 2021; 11:2545. [PMID: 33510292 PMCID: PMC7844051 DOI: 10.1038/s41598-021-81797-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/06/2021] [Indexed: 01/30/2023] Open
Abstract
Breath-hold divers (BHD) enduring apnea for more than 4 min are characterized by resistance to release of reactive oxygen species, reduced sensitivity to hypoxia, and low mitochondrial oxygen consumption in their skeletal muscles similar to northern elephant seals. The muscles and myocardium of harbor seals also exhibit metabolic adaptations including increased cardiac lactate-dehydrogenase-activity, exceeding their hypoxic limit. We hypothesized that the myocardium of BHD possesses similar adaptive mechanisms. During maximum apnea 15O-H2O-PET/CT (n = 6) revealed no myocardial perfusion deficits but increased myocardial blood flow (MBF). Cardiac MRI determined blood oxygen level dependence oxygenation (n = 8) after 4 min of apnea was unaltered compared to rest, whereas cine-MRI demonstrated increased left ventricular wall thickness (LVWT). Arterial blood gases were collected after warm-up and maximum apnea in a pool. At the end of the maximum pool apnea (5 min), arterial saturation decreased to 52%, and lactate decreased 20%. Our findings contrast with previous MR studies of BHD, that reported elevated cardiac troponins and decreased myocardial perfusion after 4 min of apnea. In conclusion, we demonstrated for the first time with 15O-H2O-PET/CT and MRI in elite BHD during maximum apnea, that MBF and LVWT increases while lactate decreases, indicating anaerobic/fat-based cardiac-metabolism similar to diving mammals.
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Jin L, Wang C, Liu J, Li P, Li J, Cui X, Wang Y. Pseudo-ginsengenin DQ ameliorated aconitine-induced arrhythmias by influencing Ca 2+ and K + currents in ventricular myocytes. RSC Adv 2020; 10:25999-26005. [PMID: 35518596 PMCID: PMC9055354 DOI: 10.1039/d0ra01683g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Pseudo-ginsengenin DQ (PDQ) is the product of the oxidative cyclization of protopanaxadiol. PDQ exhibits various bioactivities, including reversal of multidrug resistance in cancer, renal protective effects against acute nephrotoxicity and attenuating myocardial ischemia injury induced by isoproterenol or ligation of coronary arterials, but its effect on arrhythmias has not been clear until now. Because of the complicated effects of ginseng on the cardiovascular system, it is necessary to investigate whether PDQ affects arrhythmias, which are always concomitant with other cardiac diseases. Aconitine was used to induce arrhythmia in vivo. To understand its electrophysiological fundamental, whole-cell patch-clamp was used to record the L-type calcium current (ICa,L) and potassium currents (IK and IK1) in the ventricular myocytes in rats. Oral administration of PDQ exerted obvious antiarrhythmic effects, as indicated by the decreased incidence rate, lower number of occurrences, and shorter duration time of ventricular tachycardia and ventricular tachycardia, decreased mortality rate and increased survival time. ICa,L and IK were inhibited by PDQ treatment while IK1 was not affected. To conclude, PDQ may have an anti-arrhythmia effect through inhibiting ICa,L and IK. Pseudo-ginsengenin DQ (PDQ) is the product of the oxidative cyclization of protopanaxadiol. PDQ could ameliorate aconitine-induced arrhythmias by influencing Ca2+ and K+ currents in ventricular myocytes.![]()
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Affiliation(s)
- Lifang Jin
- School of Pharmaceutical Sciences
- Jilin University
- Changchun 130021
- China
- Department of Hematology and Oncology
| | - Cuizhu Wang
- School of Pharmaceutical Sciences
- Jilin University
- Changchun 130021
- China
| | - Jinping Liu
- School of Pharmaceutical Sciences
- Jilin University
- Changchun 130021
- China
| | - Pingya Li
- School of Pharmaceutical Sciences
- Jilin University
- Changchun 130021
- China
| | - Jing Li
- College of Basic Medical Sciences
- Jilin University
- Changchun
- China
| | - Xiaoli Cui
- College of Basic Medical Sciences
- Jilin University
- Changchun
- China
| | - Yi Wang
- School of Pharmaceutical Sciences
- Jilin University
- Changchun 130021
- China
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Patel JK, Figueroa A, Shah R, Korlipara H, Parikh PB. Impact of right ventricular dysfunction on mortality in adults with cardiac arrest undergoing coronary angiogram. Resuscitation 2019; 137:229-233. [PMID: 30769125 DOI: 10.1016/j.resuscitation.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/26/2019] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to identify the impact of echocardiographic right ventricular (RV) systolic dysfunction on mortality in adults with cardiac arrest (CA). METHODS The study population included 147 adults hospitalized with CA who underwent both echocardiogram and coronary angiogram at an academic tertiary medical center. The primary outcome of interest was all-cause in-hospital mortality. RESULTS Of the 147 patients studied, 20 (13.6%) had evidence of RV systolic dysfunction while 127 (86.4%) did not. Patients with RV dysfunction had higher rates of prior surgical and percutaneous coronary revascularization. They also had higher rates of mechanical ventilation, therapeutic hypothermia, vasopressor and inotrope use, and a trend towards higher rates of mechanical support. Coronary angiogram revealed higher rates of multivessel disease, right coronary artery intervention, and glycoprotein IIb-IIIa inhibitor use in those with RV dysfunction, alongside with lower echocardiographic left ventricular ejection fraction. In-hospital mortality rates were higher in adults with RV dysfunction compared to those without (55% vs 11%, p < 0.001). In multivariate analysis, RV dysfunction was the strongest independent predictor of higher mortality [odds ratio 4.71, 95% confidence interval 1.27-17.50]. CONCLUSIONS In this observational contemporary study, RV dysfunction was independently associated with higher mortality in adults with CA undergoing coronary angiogram. RV dysfunction may be useful for risk stratification and management in this high-mortality population.
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Affiliation(s)
- Jignesh K Patel
- Resuscitation Research Group, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
| | - Andrew Figueroa
- Resuscitation Research Group, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, USA
| | - Rian Shah
- Resuscitation Research Group, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, USA
| | - Haasitha Korlipara
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
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Park SH, Lim YD, Jung YH, Jeung KW. Relationship between hemodynamic parameters and severity of ischemia-induced left ventricular wall thickening during cardiopulmonary resuscitation of consistent quality. PLoS One 2018; 13:e0208140. [PMID: 30485382 PMCID: PMC6261643 DOI: 10.1371/journal.pone.0208140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022] Open
Abstract
Ischemia-induced left ventricular (LV) wall thickening compromises the hemodynamic effectiveness of cardiopulmonary resuscitation (CPR). However, accurate assessment of the severity of ischemia-induced LV wall thickening during CPR is challenging. We investigated, in a swine model, whether hemodynamic parameters, including end-tidal carbon dioxide (ETCO2) level, are linearly associated with the severity of ischemia-induced LV wall thickening during CPR of consistent quality. We retrospectively analyzed 96 datasets for ETCO2 level, arterial pressure, LV wall thickness, and the percent of measured end-diastolic volume (%EDV) relative to EDV at the onset of ventricular fibrillation from eight pigs. Animals underwent advanced cardiovascular life support based on resuscitation guidelines. During CPR, LV wall thickness progressively increased while %EDV progressively decreased. Systolic and diastolic arterial pressure and ETCO2 level were significantly correlated with LV wall thickness and %EDV. Linear mixed effect models revealed that, after adjustment for significant covariates, systolic and diastolic arterial pressure were not associated with LV wall thickness or %EDV. ETCO2 level had a significant linear relationship with %EDV (P = 0.004). However, it could explain only 28.2% of the total variance of %EDV in our model. In conclusion, none of the hemodynamic parameters examined in this study appeared to provide sufficient information on the severity of ischemia-induced LV wall thickening.
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Affiliation(s)
- Se-hyeok Park
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Deok Lim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
- * E-mail:
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Pommet S, Claret PG, de La Coussaye JE, Bobbia X. Échographie et prise en charge de l’arrêt cardiaque. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’arrêt cardiorespiratoire (ACR) est une situation fréquente pour les structures d’urgences et de réanimation, et l’utilisation de l’échographie y est recommandée par les sociétés savantes. Elle doit impérativement se faire sans augmentation des temps d’interruption du massage cardiaque externe. Après formation, elle permet de détecter rapidement et facilement la présence d’une contractilité myocardique qui est un élément pronostique important pouvant aider dans la décision d’arrêter la RCP. Le recours à des protocoles bien établis avec des équipes entraînées permet d’éviter une interruption prolongée de la RCP. Cependant, aucune étude humaine de grande ampleur n’a permis de décrire de manière fiable pendant l’ACR la sémiologie échographique des causes curables que constituent l’hypovolémie, l’embolie pulmonaire, la tamponnade et le pneumothorax compressif.
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The Right Ventricle Is Dilated During Resuscitation From Cardiac Arrest Caused by Hypovolemia: A Porcine Ultrasound Study. Crit Care Med 2017; 45:e963-e970. [PMID: 28430698 DOI: 10.1097/ccm.0000000000002464] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dilation of the right ventricle during cardiac arrest and resuscitation may be inherent to cardiac arrest rather than being associated with certain causes of arrest such as pulmonary embolism. This study aimed to compare right ventricle diameter during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, or primary arrhythmia (i.e., ventricular fibrillation). DESIGN Thirty pigs were anesthetized and then randomized to cardiac arrest induced by three diffrent methods. Seven minutes of untreated arrest was followed by resuscitation. Cardiac ultrasonographic images were obtained during induction of cardiac arrest, untreated cardiac arrest, and resuscitation. The right ventricle diameter was measured. Primary endpoint was the right ventricular diameter at the third rhythm analysis. SETTING University hospital animal laboratory. SUBJECTS Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg). INTERVENTIONS Pigs were randomly assigned to cardiac arrest caused by either hypovolemia, hyperkalemia, or primary arrhythmia. MEASUREMENTS AND MAIN RESULTS At the third rhythm analysis during resuscitation, the right ventricle diameter was 32 mm (95% CI, 29-35) in the hypovolemia group, 29 mm (95% CI, 26-32) in the hyperkalemia group, and 25 mm (95% CI, 22-28) in the primary arrhythmia group. This was larger than baseline for all groups (p = 0.03). When comparing groups at the third rhythm analysis, the right ventricle was larger for hypovolemia than for primary arrhythmia (p < 0.001). CONCLUSIONS The right ventricle was dilated during resuscitation from cardiac arrest caused by hypovolemia, hyperkalemia, and primary arrhythmia. These findings indicate that right ventricle dilation may be inherent to cardiac arrest, rather than being associated with certain causes of arrest. This contradicts a widespread clinical assumption that in hypovolemic cardiac arrest, the ventricles are collapsed rather than dilated.
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Caap P, Aagaard R, Sloth E, Løfgren B, Granfeldt A. Reduced right ventricular diameter during cardiac arrest caused by tension pneumothorax - a porcine ultrasound study. Acta Anaesthesiol Scand 2017; 61:813-823. [PMID: 28555810 DOI: 10.1111/aas.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/29/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Advanced life support (ALS) guidelines recommend ultrasound to identify reversible causes of cardiac arrest. Right ventricular (RV) dilatation during cardiac arrest is commonly interpreted as a sign of pulmonary embolism. The RV is thus a focus of clinical ultrasound examination. Importantly, in animal studies ventricular fibrillation and hypoxia results in RV dilatation. Tension pneumothorax (tPTX) is another reversible cause of cardiac arrest, however, the impact on RV diameter remains unknown. AIM To investigate RV diameter evaluated by ultrasound in cardiac arrest caused by tPTX or hypoxia. METHODS Pigs were randomized to cardiac arrest by either tPTX (n = 9) or hypoxia (n = 9) and subsequently resuscitated. Tension pneumothorax was induced by injection of air into the pleural cavity. Hypoxia was induced by reducing tidal volume. Ultrasound images of the RV were obtained throughout the study. Tension pneumothorax was decompressed after the seventh rhythm analysis. The primary endpoint was RV diameter after the third rhythm analysis. RESULTS At cardiac arrest the RV diameter was 17 mm (95% CI: 13; 21) in the tPTX group and 36 mm (95% CI: 33; 40) in the hypoxia group (P < 0.01, n = 9 for both). At third rhythm analysis RV diameter was smaller in the tPTX group: 12 mm (95% CI: 7; 16) vs. hypoxia group: 28 mm (25; 32) (P < 0.01). After decompression no difference existed between groups: tPTX 29 mm (95% CI: 23; 34) vs. hypoxia 29 mm (95% CI: 20; 38). CONCLUSION The RV diameter is smaller during cardiopulmonary resuscitation in cardiac arrest caused by tPTX when compared with hypoxia. The difference disappears after tPTX decompression.
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Affiliation(s)
- P. Caap
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
| | - R. Aagaard
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Anesthesiology; Regional Hospital of Randers; Randers Denmark
- Clinical Research Unit; Regional Hospital of Randers; Randers Denmark
| | - E. Sloth
- Department of Anesthesiology and Intensive Care Medicine East Section; Aarhus University Hospital; Aarhus Denmark
- University of Cape Town; Cape Town South Africa
| | - B. Løfgren
- Research Center for Emergency Medicine; Aarhus University Hospital; Aarhus Denmark
- Department of Internal Medicine; Regional Hospital of Randers; Randers Denmark
- Institute of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - A. Granfeldt
- Institute of Clinical Medicine; Aarhus University; Aarhus Denmark
- Department of Anaesthesiology and Intensive Care South Section; Aarhus University Hospital; Aarhus Denmark
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Aagaard R, Caap P, Hansson NC, Bøtker MT, Granfeldt A, Løfgren B. Detection of Pulmonary Embolism During Cardiac Arrest—Ultrasonographic Findings Should Be Interpreted With Caution*. Crit Care Med 2017; 45:e695-e702. [DOI: 10.1097/ccm.0000000000002334] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ewy GA. Cardiocerebral and cardiopulmonary resuscitation - 2017 update. Acute Med Surg 2017; 4:227-234. [PMID: 29123868 PMCID: PMC5674458 DOI: 10.1002/ams2.281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/13/2017] [Indexed: 12/21/2022] Open
Abstract
Sudden cardiac arrest is a major public health problem in the industrialized nations of the world. Yet, in spite of recurrent updates of the guidelines for cardiopulmonary resuscitation and emergency cardiac care, many areas have suboptimal survival rates. Cardiocerebral resuscitation, a non‐guidelines approach to therapy of primary cardiac arrest based on our animal research, was instituted in Tucson (AZ, USA) in 2002 and subsequently adopted in other areas of the USA. Survival rates of patients with primary cardiac arrest and a shockable rhythm significantly improved wherever it was adopted. Cardiocerebral resuscitation has three components: the community, the pre‐hospital, and the hospital. The community component emphasizes bystander recognition and chest compression only resuscitation. Its pre‐hospital or emergency medical services component emphasizes: (i) urgent initiation of 200 uninterrupted chest compressions before and after each indicated single defibrillation shock, (ii) delayed endotracheal intubation in favor of passive delivery of oxygen by a non‐rebreather mask, (iii) early adrenaline administration. The hospital component was added later. The national and international guidelines for cardiopulmonary resuscitation and emergency medical services are still not optimal, for several reasons, including the fact that they continue to recommend the same approach for two entirely different etiologies of cardiac arrest: primary cardiac arrest, often caused by ventricular fibrillation, where the arterial blood oxygenation is little changed at the time of the arrest, and secondary cardiac arrest from severe respiratory insufficiency, where the arterial blood is severely desaturated at the time of cardiac arrest. These different etiologies need different approaches to therapy.
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Affiliation(s)
- Gordon A Ewy
- Department of Medicine (Cardiology) University of Arizona College of Medicine Tucson AZ USA
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Cao ZP, Zhang Y, Mi L, Luo XY, Tian MH, Zhu BL. The Expression of B-Type Natriuretic Peptide After CaCl2-Induced Arrhythmias in Rats. Am J Forensic Med Pathol 2017; 37:133-40. [PMID: 27258852 DOI: 10.1097/paf.0000000000000193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate the patterns of B-type natriuretic peptide (BNP) expression after arrhythmia, BNP was assessed at different time points (0 minute, 10 minutes, 30 minutes, 1 hour, 3 hours, and 6 hours) in CaCl2-induced arrhythmia in rats through various methods such as immunohistochemistry, Western blotting, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay. Immunohistochemistry results showed that the expression of BNP in the endocardium was higher than that in the epicardium in rats undergoing sustained arrhythmias. The BNP-to-GAPDH (glyceraldehyde-3-phosphate dehydrogenase) ratios determined by Western blotting analysis revealed no change at 0 minute but increased at 10 minutes and reached the first peak (0.48 [0.03]) at 30 minutes. After a brief decline, the second peak was observed at 6 hours (0.54 [0.03]). Similar patterns of BNP messenger RNA expression were also observed by quantitative real-time polymerase chain reaction. The plasma BNP concentrations did not change after initial bouts of cardiac arrhythmias but significantly increased 30 minutes after CaCl2 injections. The results demonstrate that arrhythmia causes an elevation of BNP in the myocardium and blood, and BNP messenger RNA increases in initial arrhythmia while its protein in myocardium and plasma does not; however, both of them were elevated after sustained arrhythmia. Such an elevated BNP expression, which is directly related to the severity and duration of the arrhythmias, may suggest the existence of fatal arrhythmia in sudden cardiac death.
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Affiliation(s)
- Zhi-Peng Cao
- From the Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, Liaoning Province, People's Republic of China
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Kern KB, Hanna JM, Young HN, Ellingson CJ, White JJ, Heller B, Illindala U, Hsu CH, Zuercher M. Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post–Cardiac Arrest in a Porcine Model. JACC Cardiovasc Interv 2016; 9:2403-2412. [DOI: 10.1016/j.jcin.2016.08.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/25/2022]
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Effects of the administration of 2,3-butanedione monoxime during conventional cardiopulmonary resuscitation on ischaemic contracture and resuscitability in a pig model of out-of-hospital cardiac arrest. Resuscitation 2015; 87:26-32. [DOI: 10.1016/j.resuscitation.2014.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 11/03/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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Heradstveit BE, Heltne JK. PQRST – A unique aide-memoire for capnography interpretation during cardiac arrest. Resuscitation 2014; 85:1619-20. [DOI: 10.1016/j.resuscitation.2014.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 02/01/2023]
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Georgiou M, Papathanassoglou E, Xanthos T. Systematic review of the mechanisms driving effective blood flow during adult CPR. Resuscitation 2014; 85:1586-93. [PMID: 25238739 DOI: 10.1016/j.resuscitation.2014.08.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/27/2014] [Accepted: 08/24/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND High quality chest compressions is the most significant factor related to improved short-term and long-term outcome in cardiac arrest. However, considerable controversy exists over the mechanisms involved in driving blood flow. OBJECTIVES The aim of this systematic review is to elucidate major mechanisms involved in effective compression-mediated blood flow during adult cardiopulmonary resuscitation (CPR). DESIGN AND SETTING Systematic review of studies identified from the bibliographic databases of PubMed/Medline, Cochrane, and Scopus. SELECTION CRITERIA All human and animal studies including information on the responsible mechanisms of compression-related blood flow. DATA COLLECTION AND ANALYSIS Two reviewers (MG, TX) independently screened all potentially relevant titles and abstracts for eligibility, by using a standardized data-worksheet. MAIN RESULTS Forty seven studies met the inclusion criteria. Because of the heterogeneity in outcome measures, quantitative synthesis of evidence was not feasible. Evidence was critically synthesized in order to answer the review questions, taking into account study heterogeneity and validity. The number of included studies per category is as follows: blood flow during chest compression, nine studies; blood flow during chest decompression, six studies; effect of chest compression on cerebral blood flow, eight studies; active compression-decompression CPR, 14 studies; and effect of ventilation on compression-related blood flow, 13 studies. CONCLUSION The evidence so far is inconclusive regarding the major responsible mechanism in compression-related blood flow. Although both 'cardiac pump' and 'thoracic pump' have a key role, the effect of each mechanism is highly depended on other resuscitation parameters, such as positive pressure ventilation and compression depth.
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Affiliation(s)
- Marios Georgiou
- Nursing, American Medical Center, Nicosia, Cyprus; Cyprus Resuscitation Council, Nicosia, Cyprus
| | - Elizabeth Papathanassoglou
- Cyprus Resuscitation Council, Nicosia, Cyprus; School of Health Sciences, Cyprus Technological University of Technology, Nicosia, Cyprus
| | - Theodoros Xanthos
- National and Kapodistrian University of Athens, Medical School, Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
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The potential mechanism of the detrimental effect of defibrillation prior to cardiopulmonary resuscitation in prolonged cardiac arrest model. Lab Anim Res 2014; 30:79-83. [PMID: 24999362 PMCID: PMC4079835 DOI: 10.5625/lar.2014.30.2.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 11/23/2022] Open
Abstract
Defibrillation is no longer universally recommended as initial intervention for the reversal of ventricular fibrillation (VF) after a prolonged and untreated cardiac arrest. We sought to examine this issue in an animal model where a prolonged untreated VF was induced. The aim of this study was to investigate the potential mechanism of the detrimental effect of defibrillation prior to cardiopulmonary resuscitation (CPR) in prolonged cardiac arrest model. VF was electrically induced in 32 domestic male swine weighing 40±3 kg and remained untreated for 15 minutes. The animals were then randomly allocated to either the initial defibrillation group or the chest compression group. Mean aortic pressure, right atrial pressure and coronary perfusion pressure (CPP) were continuously measured during the performance. The dimensions of the left ventricle (LV) were assessed by echocardiographic methods. The CPP induced by CPR after defibrillation was significantly lower in the initial defibrillation group than in the chest compression group; 1 minute after defibrillation (9±3 mmHg vs. 14.8±7 mmHg (P<0.05)), and after 5 minutes 16±5 mmHg vs. 21.7±1 mmHg (P<0.05). The LV volumes were reduced from 18±2 mmHg to 14±1 mmHg after defibrillation (P<0.05). In brief, this study showed that the conducting defibrillation prior to chest compression may cause a contracture of the LV, resulting in lowering CPP, thus dropping the efficiency of chest compression in a prolonged cardiac arrest model.
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Wieling W, Krediet CTP, Solari D, de Lange FJ, van Dijk N, Thijs RD, van Dijk JG, Brignole M, Jardine DL. At the heart of the arterial baroreflex: a physiological basis for a new classification of carotid sinus hypersensitivity. J Intern Med 2013; 273:345-58. [PMID: 23510365 DOI: 10.1111/joim.12042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this review is to provide an update of the current knowledge of the physiological mechanisms underlying reflex syncope. Carotid sinus syncope will be used as the classical example of an autonomic reflex with relatively well-established afferent, central and efferent pathways. These pathways, as well as the pathophysiology of carotid sinus hypersensitivity (CSH) and the haemodynamic effects of cardiac standstill and vasodilatation will be discussed. We will demonstrate that continuous recordings of arterial pressure provide a better understanding of the cardiovascular mechanisms mediating arterial hypotension and cerebral hypoperfusion in patients with reflex syncope. Finally we will demonstrate that the current criteria to diagnose CSH are too lenient and that the conventional classification of carotid sinus syncope as cardioinhibitory, mixed and vasodepressor subtypes should be revised because isolated cardioinhibitory CSH (asystole without a fall in arterial pressure) does not occur. Instead, we suggest that all patients with CSH should be thought of as being 'mixed', between cardioinhibition and vasodepression. The proposed stricter set of criteria for CSH should be evaluated in future studies.
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Affiliation(s)
- W Wieling
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
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Pro cardiopulmonary resuscitation before defibrillation. Notf Rett Med 2012. [DOI: 10.1007/s10049-011-1567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Factors complicating interpretation of capnography during advanced life support in cardiac arrest—A clinical retrospective study in 575 patients. Resuscitation 2012; 83:813-8. [DOI: 10.1016/j.resuscitation.2012.02.021] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/07/2012] [Accepted: 02/15/2012] [Indexed: 11/19/2022]
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Chalkias A, Xanthos T. Pathophysiology and pathogenesis of post-resuscitation myocardial stunning. Heart Fail Rev 2011; 17:117-28. [DOI: 10.1007/s10741-011-9255-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sorrell VL, Paleru V, Altbach MI, Hilwig RW, Kern KB, Gaballa M, Ewy GA, Berg RA. Mild hypothermia delays the development of stone heart from untreated sustained ventricular fibrillation--a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2011; 13:17. [PMID: 21375776 PMCID: PMC3060150 DOI: 10.1186/1532-429x-13-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/06/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND 'Stone heart' resulting from ischemic contracture of the myocardium, precludes successful resuscitation from ventricular fibrillation (VF). We hypothesized that mild hypothermia might slow the progression to stone heart. METHODS Fourteen swine (27 ± 1 kg) were randomized to normothermia (group I; n=6) or hypothermia groups (group II; n=8). Mild hypothermia (34 ± 2 °C) was induced with ice packs prior to VF induction. The LV and right ventricular (RV) cross-sectional areas were followed by cardiovascular magnetic resonance until the development of stone heart. A commercial 1.5T GE Signa NV-CV/i scanner was used. Complete anatomic coverage of the heart was acquired using a steady-state free precession (SSFP) pulse sequence gated at baseline prior to VF onset. Un-gated SSFP images were obtained serially after VF induction. The ventricular endocardium was manually traced and LV and RV volumes were calculated at each time point. RESULTS In group I, the LV was dilated compared to baseline at 5 minutes after VF and this remained for 20 minutes. Stone heart, arbitrarily defined as LV volume <1/3 of baseline at the onset of VF, occurred at 29 ± 3 minutes. In group II, there was less early dilation of the LV (p<0.05) and the development of stone heart was delayed to 52 ± 4 minutes after onset of VF (P<0.001). CONCLUSIONS In this closed-chest swine model of prolonged untreated VF, hypothermia reduced the early LV dilatation and importantly, delayed the onset of stone heart thereby extending a known, morphologic limit of resuscitability.
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Affiliation(s)
- Vincent L Sorrell
- Department of Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Radiology, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Pediatrics, Steel Memorial Children Research Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Vijayasree Paleru
- Department of Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Maria I Altbach
- Department of Radiology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ronald W Hilwig
- Department of Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Karl B Kern
- Department of Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Mohamed Gaballa
- Department of Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Gordon A Ewy
- Department of Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Robert A Berg
- Department of Pediatrics, Steel Memorial Children Research Center, University of Arizona College of Medicine, Tucson, Arizona, USA
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Abstract
PURPOSE OF REVIEW The standards required for optimal effect of chest compressions and the degree to which most practice falls short of ideal have not been widely appreciated. This review highlights some of the important data now available and offers a haemodynamic explanation that broadens current concepts. RECENT FINDINGS New techniques have permitted a detailed examination of how compressions are performed in practice. The implications of recent experimental work adds a new imperative to the need for improvement. SUMMARY In addition to highlighting the need for improved training and audit, the greater understanding of mechanisms in resuscitation suggest that guidelines for management of adult cardiac arrest of presumed cardiac origin need further revision and simplification.
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Hirabayashi S, Inagaki M, Hisada T. Effects of wall stress on the dynamics of ventricular fibrillation: a simulation study using a dynamic mechanoelectric model of ventricular tissue. J Cardiovasc Electrophysiol 2008; 19:730-9. [PMID: 18284504 DOI: 10.1111/j.1540-8167.2008.01099.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To investigate the mechanisms underlying the increased prevalence of ventricular fibrillation (VF) in the mechanically compromised heart, we developed a fully coupled electromechanical model of the human ventricular myocardium. METHODS AND RESULTS The model formulated the biophysics of specific ionic currents, excitation-contraction coupling, anisotropic nonlinear deformation of the myocardium, and mechanoelectric feedback (MEF) through stretch-activated channels. Our model suggests that sustained stretches shorten the action potential duration (APD) and flatten the electrical restitution curve, whereas stretches applied at the wavefront prolong the APD. Using this model, we examined the effects of mechanical stresses on the dynamics of spiral reentry. The strain distribution during spiral reentry was complex, and a high strain-gradient region was located in the core of the spiral wave. The wavefront around the core was highly stretched, even at lower pressures, resulting in prolongation of the APD and extension of the refractory area in the wavetail. As the left ventricular pressure increased, the stretched area became wider and the refractory area was further extended. The extended refractory area in the wavetail facilitated the wave breakup and meandering of tips through interactions between the wavefront and wavetail. CONCLUSIONS This simulation study indicates that mechanical loading promotes meandering and wave breaks of spiral reentry through MEF. Mechanical loading under pathological conditions may contribute to the maintenance of VF through these mechanisms.
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Affiliation(s)
- Satoko Hirabayashi
- Computational Biomechanics Laboratory, Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan.
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Chamberlain D, Frenneaux M, Steen S, Smith A. Why do chest compressions aid delayed defibrillation? Resuscitation 2008; 77:10-5. [PMID: 18207623 DOI: 10.1016/j.resuscitation.2007.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 11/01/2007] [Accepted: 11/12/2007] [Indexed: 10/22/2022]
Abstract
The new resuscitation guidelines permit compressions before delayed, defibrillation, a change that has generally been welcomed. The benefits are generally assumed to relate to the immediate provision of limited coronary perfusion with protection or replenishment of myocardial metabolic reserves. In this paper we argue that the concept is inadequate to explain many experimental and clinical observations made during resuscitation attempts. We argue that changes in the size and shape of the ventricles are the most important reason for the narrow window of opportunity for defibrillation alone and for the value of compressions in extending this period. We also draw attention to the implication for clinical resuscitation and to one aspect of the current guidelines of the European Resuscitation Council that we believe to be inconsistent with the evidence that we review.
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Affiliation(s)
- Douglas Chamberlain
- Medical School, Cardiff University, Prehospital Emergency Care Unit, Lansdowne Hospital, Sanatorium Road, Canton, Cardiff CF1 8UL, United Kingdom.
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Cardiac magnetic resonance imaging investigation of sustained ventricular fibrillation in a swine model--with a focus on the electrical phase. Resuscitation 2007; 73:279-86. [PMID: 17241733 DOI: 10.1016/j.resuscitation.2006.08.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 08/14/2006] [Accepted: 08/14/2006] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to develop a method to evaluate the rapidly changing cardiac dimensions during sustained ventricular fibrillation (VF). We also present details of our CPR research imaging program to facilitate this avenue of clinically important research. BACKGROUND The changes in cardiac dimensions occurring during the initial critical electrical phase of sustained VF are not entirely known. Conventional cardiac magnetic resonance imaging (CMR) functional imaging lacks the temporal resolution necessary to capture the dynamic changes within this early time period of sustained VF. We hypothesized that changes in the middle short axis slice of the ventricles will reflect changes in ventricular volumes accurately. METHODS Ventricular dimensions were determined from CMR for 30 min of untreated VF in a closed chest, closed pericardium model in seven swine. Ungated steady-state free precession images (SSFP) from the cardiac base to the apex were acquired, taking care to align the anatomical short axis (SAX) imaging planes maximally. The middle slice of the ventricles was determined as the mathematical center of the stack of SAX slices. We then compared the relative changes of right ventricle (RV) and left ventricle (LV) volumes to relative changes in mid-ventricular single slice area. RESULTS During 30 min of sustained VF, there was an excellent correlation between the changes in exact mid-slice area and the quantitative changes in ventricular volumes (r(2)>0.95). CONCLUSIONS Mid-slice area data can be used as a surrogate marker of prompt ventricular volume changes during VF. By imaging the heart 10 times faster, the rapid anatomical changes occurring during the initial few minutes of sustained VF can be understood better.
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Abstract
PURPOSE OF REVIEW This review will summarize the available data regarding the haemodynamic changes occurring following cardiac arrest in humans and animal models. RECENT FINDINGS Following cardiac arrest due to ventricular fibrillation without cardiopulmonary resuscitation, blood flow exponentially falls but continues for approximately 5 min until the pressure gradient between the aorta and the right heart is completely dissipated. During cardiopulmonary resuscitation forward flow occurs into the aorta during the compression phase. Coronary blood flow is retrograde during the compression phase and antegrade during the decompression phase. Carotid blood flow takes over a minute to reach plateau levels following the initiation of chest compressions, and even brief interruptions of compressions result in a dramatic reduction in carotid blood flow which takes a minute or so to recover to plateau levels when compressions are reinstituted. Coronary perfusion pressure during the release phase of cardiopulmonary resuscitation has been shown to be a powerful predictor of the likelihood of recovery of spontaneous circulation following restoration of electrical activity. SUMMARY Recent studies have provided important insights into the haemodynamics of cardiac arrest and of cardiopulmonary resuscitation which may inform more effective strategies for the management of cardiac arrest in the future.
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Affiliation(s)
- Peter Andreka
- Department of Cardiology, Gottsegen National Institute of Cardiology, Budapest, Hungary, UK
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