Pneumatosis intestinalis and hepatic portal venous gas are usually associated with severe intra-abdominal pathologies. As diagnostic technologies advanced, a number of variant etiologies have been identified. We report 2 cases in which pneumatosis intestinalis and hepatic portal venous gas developed after prolonged cardiopulmonary resuscitation (CPR). The pathogenic mechanism was most ...

Adverse reactions to volatile anesthetics and depolarizing muscle relaxants can occur in patients with Duchenne muscular dystrophy (DMD) resulting in acute rhabdomyolysis and hyperkalemia. We report a case of hyperkalemic cardiac arrest after cardiac surgery using cardiopulmonary bypass in a child with unsuspected DMD. Early diagnosis and management of hyperkalemia ...

Intervention for cardiac arrest may require intervention for electrical abnormalities or hemodynamic instability. These actions can result in ineffective cardiac functioning and systemic hypotension. Vasopressors are capable of improving severe hypotension that can result from reduced cardiovascular contractility or heart rate. These vasopressor actions are critical to successful resuscitation efforts ...

BACKGROUND: Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. SETTING: All patients suffering an OHCA in Stockholm and Goteborg between ...

Open, direct cardiac massage (OCM), as a technique of resuscitation has not been very inspiring due to its various limitations. We report a case of resuscitation where open 'indirect' cardiac massage was used to resuscitate a neonate successfully. A 24 hr old neonate with multiple gastrointestinal anomalies presented for emergency ...

Kinins exert cardioprotective effects via 2 G-protein-coupled receptors, B1 and B2. Using B1 kinin receptor gene knockout mice (B1-/-), we tested the hypotheses that the B1 receptor plays an important role in preservation of cardiac function, whereas lack of B1 may accelerate cardiac remodeling and dysfunction after myocardial infarction, and ...

BACKGROUND: Modified ultrafiltration has been shown to reverse haemodilution and improve ventricular function following cardiopulmonary bypass. There has been concern, however, about the safety and efficacy of modified ultrafiltration after the first stage of Norwood reconstruction for palliation of neonates with hypoplasia of the left heart and its variants. METHODS: ...

A 35-year-old Chinese man presented with acute thyrotoxic periodic paralysis complicated by near-fatal cardiac arrhythmias due to persistent hypokalaemia, despite maximum potassium supplementation. He was eventually resuscitated with external cadioversion. In this unusual case of severe refractory hypokalaemia leading to ventricular fibrillation in a patient with underlying thyrotoxicosis, the potential ...

Sudden cardiac arrest due to blunt anterior chest wall impact (Commotio Cordis) usually occurs in young athletes who are struck by a baseball or other projectile in the precordium. Survival is extremely rare if the induced ventricular fibrillation (VF) is not defibrillated immediately at the scene. We report here a ...

PURPOSE: The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Goteborg and to identify implications for public access defibrillation (PAD). METHODS: Ambulance run reports for the years 1994-2002 were studied retrospectively and manually to establish the location of the cardiac ...

Out-of-hospital cardiac arrests account for approximately 1000 sudden cardiac deaths per day in the United States. Since its introduction in 1960 closed-chest cardiac massage (CCCM) often takes place as an attempt at resuscitation, although its survival rates are low. Other resuscitation techniques are available to physicians such as open-chest cardiopulmonary ...

Although arginine vasopressin (AVP) has been shown to be a promising drug during cardiopulmonary resuscitation (CPR), concern has been raised about the potential for AVP-mediated vasoconstriction of the coronary arteries. In a prospective, randomized laboratory investigation employing an established porcine model, the effects of AVP on haemodynamic variables, left anterior ...

OBJECTIVE: The San Francisco Fire Department deployed an automated, load-distributing-band chest compression device (AutoPulse, Revivant Corporation) to evaluate its function in a large urban emergency medical services (EMS) service. A retrospective chart review was undertaken to determine whether the AutoPulse had altered short-term patient outcome, specifically, return of spontaneous circulation ...

INTRODUCTION: Carotid Blowout Syndrome (CBS) carries an exceedingly high mortality rate. Various established endovascular techniques are successful in treating less acute CBS, but exsanguinating patients with hemodynamic compromise continue to pose a significant clinical challenge. METHODS: We report a 53-year-old male with squamous cell carcinoma of the anterior tongue presented ...

Acute myocardial infarction and sudden cardiac death are more common on Mondays than other days of the week. The stress of returning to work at the beginning of the week has been postulated as a possible trigger factor. This project examined the weekly variation of out-of-hospital cardiac arrests of nontraumatic ...

We report on a favourable case of MCAD deficiency (homozygous 985A > G) that presented as lethargy, poor feeding, pulmonary haemorrhage and cardiac arrest without hypoglycaemia. The cessation of intralipid and the commencement of carnitine supplementation were associated with a rapid clinical improvement. CONCLUSION: Mild carnitine depletion and secondary impairment ...

In view of the limitations of current cardiac gene transfer techniques by direct myocardial injection, or via the coronary vasculature, we have been attempting to develop potentially clinically applicable methods. Selective catheterization of the coronary arteries has been performed, but the duration of exposure of the heart to the virus ...

PURPOSE: We examined the changes in evoked spinal cord potentials (ESCP) during profound hypothermic circulatory arrest to estimate the safe ischemic time. METHODS: We monitored ESCPs during surgery for descending thoracic or thoracoabdominal aneurysms in five patients. Evoked spinal cord potential recordings were obtained before cooling (baseline), then every few ...

Cardiovascular disease is the leading cause of death in the United States. Acute myocardial infarction (MI) is defined as necrosis of myocardial cells. Several studies have shown that cardiac markers are elevated after successful cardiopulmonary resuscitation (CPR) due to physical as well as electrical trauma. Correlation has never been established ...

Anoxic brain injury is a common outcome after cardiac arrest. Despite substantial research into the pathophysiology and management of this injury, a beneficial treatment modality has not been previously identified. Recent studies show that induced hypothermia reduces mortality and improves neurological outcomes in patients resuscitated from ventricular fibrillation. This article ...

PURPOSE OF REVIEW: This article is a review of the most recent findings in resuscitation techniques in advanced cardiac life support. The article focuses particularly on the period after July 1, 2003, but relevant new findings before this period are also included. RECENT FINDINGS: Randomized clinical trial results suggest that ...

INTRODUCTION: It is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team (MET) system can be sustained. METHOD: We conducted a prospective, controlled before-and-after examination of the effect of a MET system on the long-term incidence of cardiac arrests. We included ...

In the present study, we examined the relationships between whole brain volume (WBV), subcortical hyperintensities (SH), indices of cardiac disease and cognitive function in nondemented cardiac patients with evidence of mild cerebrovascular disease. A total of 27 individuals with evidence of cardiac disease underwent neuropsychological examination, neuroimaging, and cardiac assessment. ...

The development of high-resolution ultrasound has allowed detailed examination of the fetal heart. The accuracy of fetal echocardiography in the diagnosis of malformations of the fetal heart has been established in the second trimester and, more recently, at a much earlier stage in gestation (Allan et al., 1980; Allan et ...

The heart is often perceived as a difficult organ to understand by ultrasound during fetal life. This is undoubtedly reflected in the low detection rate of cardiac abnormalities as compared to those of most other organ systems in the fetus. In this article we start by updating classical concepts of ...

OBJECTIVES: To investigate the effects of the ultrapotent poly(adenosine 5'-diphosphate-ribose) polymerase (PARP) inhibitor INO-1001 on cardiac and mesenteric function during reperfusion in an experimental model of cardiopulmonary bypass with cardioplegic arrest. DESIGN: Prospective, randomized, and blinded experimental study. SETTING: Research laboratory. SUBJECTS:: Twelve anesthetized dogs underwent cardiopulmonary bypass with hypothermic ...

BACKGROUND: We have previously shown in dogs that exsanguination cardiac arrest of up to 120 minutes without trauma under profound hypothermia induced by aortic flush (suspended animation) can be survived without neurologic deficit. In the present study, the effects of major trauma (laparotomy, thoracotomy) are explored. This study is designed ...

What is the successful cardiopulmonary resuscitation? It is the few minutes postcardiopulmonary arrest that can answer. Twenty to 40 percent of patients who sustained cardiac arrest are initially resuscitated, but only 10% survive to hospital discharge, and more than 60% of victims succumb within 24 hours. This high fatality rate ...

Randomised, controlled trials of therapeutic hypothermia have demonstrated improved outcomes after out-of-hospital cardiac arrest, where the initial cardiac rhythm was ventricular fibrillation. This therapy is now endorsed by the International Liaison Committee on Resuscitation. The role of therapeutic hypothermia in patients with anoxic neurological injury due to stroke, spinal cord ...

Despite many years of clinical and experimental research, the contribution of cardiopulmonary bypass (CPB) and cardioplegic arrest to morbidity and mortality following cardiac surgery remains unclear. This is due, in part, to lack of suitable control group against which bypass and cardioplegic arrest can be compared. The recent success of ...

STUDY OBJECTIVE: To determine the incidence and etiology of cardiopulmonary arrest during emergency intubation in the remote location by comparing two periods (1990-1995 vs. 1995-2002) at the same institution to assess whether immediate access to advanced airway devices and endotracheal tube-verifying devices altered the incidence of hypoxemia-driven cardiac arrest. DESIGN: ...

Over the past decade the practice of acute resuscitation and its monitoring have undergone significant changes. Utilization of noninvasive mechanical ventilation, goal-directed therapy, restricted fluid volume, blood transfusion and minimally invasive technology for monitoring tissue oxygenation have changed the practice of acute resuscitation. Early diagnosis and definitive treatment of the ...

BACKGROUND: Neuromuscular blockade should, for ethical reasons, not be allowed in animal experiments unless the use is strongly motivated. Beforehand, the anaesthetic protocol must be documented without muscle relaxation in the species studied. Documentation is difficult to obtain from the scientific literature. When focusing on cardiac function over time, in ...

Even with the benefit of cardiopulmonary resuscitation, the prognosis of cardiac arrest remains poor. Multiple case series describe survival with the use of thrombolytic therapy for refractory cardiac arrest. Presumably thrombolysis treats that subset of cardiac arrest cases resulting from fulminant pulmonary embolism, or perhaps massive myocardial infarctions. Published reports ...

The science and technology of CPR is only just emerging from its infancy. However, substantial improvements are anticipated, including the ability of lay rescuers to identify cardiac arrest promptly, the availability of additional measurements, and expanded intelligence provided by expanded AEDs with which to more effectively prompt the rescuer through ...

BACKGROUND: Omega-3 fatty acids (FAs) appear to reduce the risk of sudden death from myocardial infarction. This reduction is believed to occur via the incorporation of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into the myocardium itself, altering the dynamics of sodium and calcium channel function. The extent of incorporation ...

We present a case of a 29-year-old female patient who had presented to us for the management of her chronic right shoulder-hand pain and developed a sinus arrest following a right-sided stellate ganglion block (RSGB). This patient on receiving a diagnostic RSGB via the anterior paratracheal (C6) approach developed sinus ...

OBJECTIVES: To evaluate the factors affecting the outcome of in-hospital cardiac arrest. SETTING: A 1400-bed tertiary care teaching hospital with a dedicated cardiac arrest team (CAT). The CAT was immediately available in monitored areas (intensive care unit and emergency room). In the wards the staff had only BLS skills and ...

Sudden cardiac arrest occurs when the heart's electrical system fires very rapidly and in an uncoordinated manner, rendering the heart incapable of pumping blood through the circulatory system. The heart begins to tremble uncontrollably, like a quivering bowl of jelly. The victim becomes unconscious, stops breathing, and typically has no ...

As documented in this study, 19 percent were found to have a significant risk of having a cardiac arrest. The impressive ROI calls out to other organizations that cardiac arrest testing is a good use of funds. But more important, yet more difficult to define, is the human impact. Cost ...

OBJECTIVES: The aims of this study were to describe the trends of ventricular fibrillation (VF) out-of-hospital cardiac arrest in Rochester, Minnesota, since 1985 and to determine coexistent trends in implantable cardioverter defibrillator (ICD) placement and termination of potentially lethal ventricular arrhythmias that might explain, at least in part, a declining ...

OBJECTIVE: To compare the effect on postresuscitation left ventricular function of vasopressin vs. epinephrine used during cardiopulmonary resuscitation in a swine model of prolonged prehospital ventricular fibrillation. DESIGN: Prospective, randomized experimental study. SETTING: University large animal resuscitation research laboratory. SUBJECTS: Forty-eight swine (29 +/- 1 kg). INTERVENTIONS: Resuscitation after 12.5 ...

OBJECTIVE: In patients undergoing cardiopulmonary resuscitation, circulating endogenous vasopressin concentrations were significantly higher in successfully resuscitated patients than in patients who died. These observations have prompted several investigations to assess the role of vasopressin to improve cardiopulmonary resuscitation management. DESIGN: Literature review. RESULTS: In the cardiopulmonary resuscitation laboratory, vasopressin improved ...

We report an 11-year-old male with undiagnosed myopathy, who developed cardiac arrest secondary to severe rhabdomyolysis and hyperkalemia following succinylcholine administration. The patient required extracorporeal membrane oxygenation support from which he was eventually weaned successfully. He died eleven days after the cardiac arrest as a result of apparent ischemic brain ...

BACKGROUND: Intraoperative regional myocardial acidosis (RMA) during cardiac surgery has been shown to be reflective of regional myocardial ischemia and an independent predictor of adverse postoperative outcomes. This study identifies the determinants of intraoperative RMA. METHODS: Intramyocardial tissue pH(37C) in the anterior and posterior LV walls was measured in 641 ...

The use of echocardiography in the ED is well established and continues to gain widespread use in the evaluation of critically ill patients. In certain circumstances such as chest trauma, pericardial effusion, and cardiac arrest,EPs can perform and interpret echocardiographic examinations reliably. In other circumstances such as the diagnosis of ...

OBJECTIVE: Left ventricular dysfunction after successful cardiopulmonary resuscitation contributes to early death following resuscitation. The stress-induced proinflammatory cytokines, particularly tumor necrosis factor-alpha and interleukin-1beta, are known to depress myocardial function. We hypothesized that tumor necrosis factor-alpha and interleukin-1beta, synthesized and released in response to the stress of global ischemia accompanying ...

A professional rugby league player sustained a left eyebrow laceration during a match which immediately started to bleed. Within seconds he was taken to the sideline and had the laceration closed with six staples by the team doctor. Bleeding was arrested and he returned to play, taking the ball within ...

BACKGROUND: Perinatal asphyxia is associated with cardiac dysfunction, and it is important to prevent further tissue injury during resuscitation. There is increasing evidence that myocardial matrix metalloproteinases (MMPs) are involved in myocardial hypoxaemia-reoxygenation injury. OBJECTIVE: To assess MMPs and antioxidant capacity in newborn pigs after global ischaemia and subsequent resuscitation ...

BACKGROUND: Measuring survival from sudden out-of-hospital cardiac arrest (OOH-CA) is often used as a benchmark of the quality of a community's emergency medical service (EMS) system. The definition of OOH-CA survival rates depends both upon the numerator (surviving cases) and the denominator (all cases). PURPOSE: The purpose of the public ...