OBJECTIVE: To evaluate the effects of therapeutic hypothermia (HT) of 33 degrees C after cardiac arrest (CA) on cardiac arrhythmias, heart rate variability (HRV), and their prognostic value. DESIGN: Prospective, comparative substudy of a randomized controlled trial of mild HT after out-of-hospital CA, the European Hypothermia After Cardiac Arrest study. ...

Topical hemostatic agents are frequently used in spine surgeries to control or reduce bleeding. Although there are a number of commercially available products, at our institution, an absorbable gelatin powder (Surgifoam) is mixed with bovine thrombin and used for this purpose. We report the case of a patient undergoing a ...

BACKGROUND: Circulatory load during hypoxia is unavoidable in donation after cardiac death (DCD) hearts, but it causes severe myocardial damage. The impact of circulatory load on donor heart function has not been investigated. The purpose of this study was to evaluate its effect on post-transplant functional recovery of DCD hearts. ...

Echocardiographic images have been reported after a cardiac arrest and in patients with critical risk for a cardiac arrest. We present the sequence of a cardiac arrest in an 82-year-old Italian man with acute myocardial infarction, during an echocardiographic evaluation. This case is illustrative of an echocardiographic sequence of a ...

The purpose of this review was to provide a critical evaluation of medical literature on so-called "cardiac cephalgia" or "cardiac cephalalgia". The 2004 International Classification of Headache Disorders codes cardiac cephalgia to 10.6 in the group of secondary headaches attributed to disorder of homoeostasis. This headache is hardly recognizable and ...

Cardiocerebral resuscitation (CCR) is a new approach for resuscitation of patients with cardiac arrest. It is composed of 3 components: 1) continuous chest compressions for bystander resuscitation; 2) a new emergency medical services (EMS) algorithm; and 3) aggressive post-resuscitation care. The first 2 components of CCR were first instituted in ...

An otherwise healthy 28-year-old man had a cardiac arrest after a day of motocross racing. He had consumed excessive amounts of a caffeinated "energy drink" throughout the day. We postulate that a combination of excessive ingestion of caffeine- and taurine-containing energy drinks and strenuous physical activity can produce myocardial ischaemia ...

Reperfusion injury induced by cardiac arrest and resuscitation leads to secondary challenges to the brainstem. A 12-minute cardiac arrest results in about a 50% survival rate in resuscitated rats over a 4-day recovery period. We investigated hypoxic ventilatory response (HVR) to mild hypoxia by measuring the minute volume before and ...

BACKGROUND: The purpose of this prospective study was to evaluate the current incidence, survival, morbidity, and predictors of mortality for open sternotomy at our center. METHODS: Prolonged open chest was used in 126 of 2485 cardiac operations (5.0%) between June 2006 and January 2008. The indications were hemodynamic instability (98), ...

The application of Advanced Cardiac Life Support (ACLS) in severe hypothermic cardiac arrest remains controversial. While the induction of mild hypothermia has been shown to improve outcomes in patients already resuscitated from cardiac arrest, it is unknown whether ACLS protocols are effective during the resuscitation of the severely hypothermic cardiac ...

"SHL" Telemedicine (established 1987 in Israel) provides professional care to subscribers who use cardiobeepers and contact its medical call center via telecommunication networks. The extended 6-month Acute Coronary Syndrome Israel Survey (ACSIS) 2004 involved all 26 intensive cardiac care units in Israeli hospitals. We compared the 1-year survival rates of ...

Approximately 80% of patients who are successfully resuscitated from cardiac arrest do not regain consciousness immediately after return of spontaneous circulation, and may remain in a coma for hours or weeks, or even be in a persistent vegetative state. Recent investigations have focused on the identification of early clinical characteristics ...

OBJECTIVE: To evaluate the relationship of the presenting features of acute coronary syndrome (ACS) to in-hospital adverse events (total and cardiac deaths, heart failure and serious dysrhythmia) and the effects of coronary intervention. BACKGROUND: Patients with ACS may present with dyspnea, shock and/or cardiac arrest with or without accompanying chest ...

Prediction of outcomes in ST-elevation myocardial infarction with cardiac arrest often presents difficult clinical decision making. Using the observed results from our institution's data, we introduce a customized, computer-based decision support tool to assist in evaluating and predicting outcomes in such situations. We conclude that this tool can be beneficial ...

Despite advances in resuscitation methods, survival after out-of-hospital cardiac arrest remains low, at least in part, due to postcardiac arrest circulatory and neurologic failure. To elucidate the role of nitric oxide (NO) in the recovery from cardiac arrest and cardiopulmonary resuscitation (CPR), we studied the impact of NO synthase (NOS3)/cGMP ...

Cardiac arrest caused by startling stimuli, such as visual and vibration stimuli, has been reported in some animals and could be considered as an extraordinary case of bradycardia and defined as reversible missed heart beats. Variability of the heart rate is established as a balance between an autonomic system, namely ...

BACKGROUND: Cardiac arrest victims most often collapse at home, where only a modest proportion receives life-saving bystander cardiopulmonary resuscitation. As many as 40% of all sudden cardiac arrest victims have agonal or abnormal breathing in the first minutes following cardiac arrest. 9-1-1 call takers may wrongly interpret agonal breathing as ...

We are reporting an extremely prolonged sinus arrest documented by Holter monitoring.

BACKGROUND: Mild therapeutic hypothermia following cardiac arrest is neuroprotective, but its effect on myocardial dysfunction that is a critical issue following resuscitation is not clear. This study sought to examine whether hypothermia and the combination of hypothermia and pharmacological postconditioning are cardioprotective in a model of cardiopulmonary resuscitation following acute ...

Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to ...

Victims of severe hypothermia and cardiac arrest may appear dead. They are often unresponsive to on-scene resuscitation including defibrillation while profoundly hypothermic. Several cases of extreme hypothermia and prolonged cardiac arrest with good outcome have been published. We present a case of heart rate monitored (by pulse-watch) hypothermia, prolonged cardiac ...

An 80 years old man suffered a cardiac arrest shortly after arrival to his local health department. Basic Life Support was started promptly and nine minutes later, on evaluation by an Advanced Life Support team, the victim was defibrillated with a 200J shock. When orotracheal intubation was attempted, masseter muscle ...

BACKGROUND: Cardiac arrest remains one of the leading causes of death worldwide. European Resuscitation Council Guidelines for Resuscitation 2005 recommend epinephrine for its treatment. OBJECTIVES: To estimate whether the administration of a vasodilatator such as nitroglycerin in combination with epinephrine during cardiopulmonary resuscitation would improve resuscitation outcome in an established ...

BACKGROUND: The poor prognosis of primary percutaneous coronary intervention (PCI) in patients resuscitated from cardiac arrest complicating acute ST-segment elevation myocardial infarction (STEMI) may at least partly be explained by the common presence of cardiogenic shock. This study examined the impact of emergency primary PCI on outcome in patients with ...

This article highlights studies in three major domains of potential mechanisms of sudden unexplained death in epilepsy (SUDEP): cardiac, respiratory, and autonomic. Ictal cardiac arrest is a clinically rare but well-recognized potential mechanism of SUDEP. Studies have failed to identify preexisting cardiac electrophysiologic or structural abnormalities that distinguish SUDEP persons. ...

About 17 million people worldwide die from cardiovascular diseases each year. Impaired neurologic function after sudden cardiac arrest is a major cause of death in these patients. Up to now, no specific post-arrest therapy was available to improve outcome. Recently, two randomized clinical trials of mild therapeutic hypothermia after successful ...

Severe palmar and/or axillary hyperhidrosis can be socially and psychologically very disturbing. We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T(2)-T(3) sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will ...

After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly ...

Recent concerns of adverse cardiac events associated with drugs used to treat attention-deficit-hyperactivity disorder (ADHD) have prompted debate over whether these drugs are truly safe. We describe a 17-year-old boy with a normal baseline echocardiogram who had been taking methylphenidate for ADHD for 18 months and experienced cardiac arrest. Emergency ...

PURPOSE OF REVIEW: To present a new approach to patients with cardiac arrest that improves neurologically normal survival. It is called cardiocerebral resuscitation (CCR), rather than cardiopulmonary resuscitation, as the major goal in cardiac arrest is to resuscitate the heart and the brain. CCR has three components: continuous chest compressions ...

OBJECTIVE: The etiology of postresuscitation myocardial stunning is unknown but is thought to be related to either ischemia occurring during cardiac arrest and resuscitation efforts and/or reperfusion injury after restoration of circulation. A potential common pathway for postischemia/reperfusion end-organ dysfunction is microvascular injury. We hypothesized that myocardial microcirculatory function is ...

Myocardial protection may be compromised in situations with a patent left internal mammary artery (LIMA) graft or an unclamped aorta. Because of collateral coronary blood flow, electrical arrest may not be achieved. Currently, hypothermia is often used to augment myocardial protection and provide cardiac arrest in these situations. We report ...

OBJECTIVE: To compare resuscitation outcomes and myocardial function among intra-arrest head cooling, delayed surface cooling, and uncooled controls. DESIGN: Prospective animal study. SETTING: University-affiliated animal research laboratory. SUBJECTS: Twenty-four male domestic pigs. INTERVENTIONS: Ventricular fibrillation remained untreated for 10 mins after which animals were assigned into three groups: 1) intra-arrest ...

A 36-year-old male with acute myeloid leukaemia was treated with liposomal amphotericin B for a breakthrough fungal infection with Absidia corymbifera during voriconazole and caspofungin therapy for invasive pulmonary aspergillosis. Four episodes of hyperkalaemia developed with a highly probable relation to infusion of liposomal amphotericin B, of which the last ...

Prehospital cardiac arrest is associated with a very poor prognosis. We report a case of complete neurological recovery after prolonged resuscitation involving the use of tenecteplase in a patient with undifferentiated cardiac arrest with a return of spontaneous circulation after 1 hour of resuscitation, where basic life support was commenced ...

OBJECTIVE: Observational studies have shown that muscular stimulation contracting the thoracic cage may produce coronary perfusion pressures equal to manual chest compressions. This study examined electrical cardiopulmonary resuscitation for coronary perfusion pressures during ventricular fibrillation in a porcine model of cardiac arrest. DESIGN: Prospective randomized controlled study. SETTING: University affiliated ...

OBJECTIVE: Erythropoietin has been noted for its cardioprotective effects. The objective of the study is to investigate its effects on postresuscitation myocardial dysfunction and therapeutic windows. DESIGN: Randomized animal study. SETTING: Animal research laboratory. SUBJECTS: Adult male adult Wistar rats. INTERVENTIONS: Cardiopulmonary resuscitation was started after 6.5 or 9.5 mins ...

BACKGROUND: Coronary heart disease is the most frequent cause of cardiac arrest. Return of spontaneous circulation is often not achieved during resuscitation due to the inability to restore coronary blood flow. OBJECTIVE: To review the literature with the aim of documenting if coronary angiography and subsequent percutaneous coronary intervention is ...

AIMS: The Hypothermia after Cardiac Arrest (HACA) trial assessed whether mild therapeutic hypothermia improved the rate of good neurological recovery in patients after ventricular fibrillation cardiac arrest of presumed cardiac origin. We evaluated the impact of hypothermia on myocardial injury. METHODS: Re-analysis of a HACA trial subset for our department ...

Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival. Using ...

AIM OF THE REVIEW: To review the epidemiology, pathophysiology, treatment and prognostication in relation to the post-cardiac arrest syndrome. METHODS: Relevant articles were identified using PubMed, EMBASE and an American Heart Association EndNote master resuscitation reference library, supplemented by hand searches of key papers. Writing groups comprising international experts were ...

OBJECTIVES: The only large-scale report (1988) by the Israeli national ambulance service Magen David Adom (MDA) on the outcome of cardiac arrest victims who underwent cardiopulmonary resuscitation (CPR) by paramedics called for more frequent and more promptly initiated CPR and shorter time to arrival of paramedic care to improve survival. ...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. ...

Cardiac dysfunction following acute myocardial infarction is a major cause of death in the world and there is a compelling need for new therapeutic strategies. In this report we demonstrate that a direct cardiac injection of drug-loaded microparticles, formulated from the polymer poly(cyclohexane-1,4-diylacetone dimethylene ketal) (PCADK), improves cardiac function following ...

Cardiopulmonary resuscitation (CPR) is now the standard treatment for someone having a cardiac arrest. It is, however, a procedure that has emerged only relatively recently. For a number of scientific and religious reasons, it was long considered impossible, even blasphemous, to attempt to reverse 'death'. Because of these factors, the ...

Past studies have clearly established that matrix metalloproteinases (MMPs) contribute to adverse myocardial remodeling with ischemia and reperfusion. However, these studies measured MMP levels in extracted samples, and therefore whether and to what degree actual changes in interstitial MMP activity occur within the human myocardium in the context of ischemia/reperfusion ...

BACKGROUND: Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. METHODS AND RESULTS: A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging ...

OBJECTIVES: To evaluate the use of extracorporeal membrane oxygenation in prolonged cardiopulmonary resuscitation and to estimate how long cardiopulmonary resuscitation can be extended with acceptable results. DESIGN: Review of consecutive adult in-hospital cardiopulmonary resuscitation patients without return of spontaneous circulation in 10 mins and with extracorporeal membrane oxygenation rescue, and ...

Tako-Tsubo Cardiomyopathy (TTC) is described as transient left ventricular (LV) dysfunction without coronary artery stenoses. Typically the onset of TTC-syndrome is following emotional or physical stress. As an acute cardiac syndrome it is mimicking ST-elevation myocardial infarction. In this case we report from a 73-year old woman presenting with cardiac ...

OBJECTIVE: The objective of this study was to determine whether a trained rescuer could teach untrained bystanders to perform basic life support (BLS) during a simulated cardiac arrest. METHOD: Volunteers were recruited from hospital ancillary staff and relatives of patients attending an emergency department. None had previous formal training in ...