Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder characterized by a pentad of microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, fever, and a fluctuating neurologic syndrome. Splenectomy is performed for patients who are refractory to plasma therapy and for relapsing TTP. We describe a case of a patient who died due ...

BACKGROUND: Historical reports indicate that active rewarming with extracorporeal membrane oxygenation (ECMO) can salvage a patient after hypothermic cardiac arrest. We created a protocol that includes ECMO for extreme hypothermia to guide rewarming of the hypothermic patient. METHODS: A retrospective review of the ECMO rewarming protocol (2004-2006) was conducted. RESULTS: ...

Therapeutic hypothermia is an exciting new treatment modality that has been shown to have significantly improved outcomes in comatose survivors of cardiac arrest. One of the exclusion criteria of the landmark studies on therapeutic hypothermia was a potential toxin-induced cause of the persistent comatose state and presumably of the cardiac ...

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether open chest cardiac massage is superior to closed chest compressions in patients suffering cardiac arrest following cardiac surgery. Using the reported search, 527 papers were identified. Fifteen papers represented the best ...

BACKGROUND: Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises, cardiovascular dysfunction, and blood loss. The safety of vasopressors and the benefit of aprotinin during concomitant octreotide administration are uncertain. METHODS: We reviewed the effects of vasopressors and aprotinin on octreotide administration and mortality ...

Cessation of circulation during cardiac arrest causes critical end-organ ischemia. Although the neurological consequences of cardiopulmonary arrest can be catastrophic, an aggressive "push fast and push hard" resuscitation technique maintains blood flow until the return of spontaneous circulation. However, reperfusion to the cerebrum leads to cellular chaos and further neurological ...

INTRODUCTION: Public access defibrillation (PAD) has shown potential to increase cardiac arrest survival rates. OBJECTIVES: To describe the geographic epidemiology of prehospital cardiac arrest in Singapore using geographic information systems (GIS) technology and assess the potential for deployment of a PAD program. METHODS: We conducted an observational prospective study looking ...

Therapeutic hypothermia (TH) after cardiac arrest (CA) improves outcomes in a fraction of patients. To enhance the administration of TH, we studied brain electrophysiological monitoring in determining the benefit of early initiation of TH compared to conventional administration in a rat model. Using an asphyxial CA model, we compared the ...

Alternation of cardiac action potential duration (APD) from beat to beat and concurrent alternation of the amplitude of the calcium transient are regarded as important arrhythmia mechanisms. These phenomena are causally interrelated and can be reliably evoked by an increase in beat frequency or by ischemia. The first part of ...

Actually recommended by the International Liaison Committee on Resuscitation (ILCOR), therapeutic hypothermia has been the only modality shown to improve neurological outcomes after cardiac arrest. This article provides the background for such recommendations as well as: pathophysiology, review of brain injury during cardiac arrest, discussion of beneficial effects of therapeutic ...

BACKGROUND: The diameter pulse waveforms (DPWs) are known to reflect the pressure waveforms at the target vessel. Our purpose was to clarify the usefulness of DPWs recorded noninvasively from the fetal inferior vena cava (IVC) for detecting cardiac function. METHODS: A paired ultrasonic phase-locked echo tracking system was used to ...

BACKGROUND: It is widely known that more boys are born during and immediately after wars, but there has not been any ultimate (evolutionary) explanation for this 'returning soldier effect'. Here, I suggest that the higher sex ratios during and immediately after wars might be a byproduct of the fact that ...

Cardiac arrest is a condition frequently encountered by physicians in the hospital setting including the Emergency Department, Intensive Care Unit and medical/surgical wards. This paper reviews the current literature involving the use of ultrasound in resuscitation and proposes an algorithmic approach for the use of ultrasound during cardiac arrest. At ...

OBJECTIVE: Cardiac ascites remains a rare entity with unique clinical and pathogenetic features that are not adequately recognized by clinicians. The purpose of this study was to contribute towards elucidating the nature of cardiac ascites. MATERIAL AND METHODS: We describe a series of 26 ascitic fluid samples from eight patients ...

OBJECTIVE: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. MATERIALS AND METHODS: All perioperative cardiac arrests in adults that occurred ...

Left ventricular noncompaction (LVNC) is an uncommon disorder that has recently been recognized as a distinct cardiomyopathy. LVNC is thought to result from an arrest in the normal process of myocardial compaction. The association of Wolff-Parkinson-White with noncompaction of the left ventricle is well recognized. Sinus bradycardia has also been ...

This article introduces 2 new cardiopulmonary resuscitation (CPR) concepts: (1) the use of only rhythmic abdominal compression (OAC) to produce blood flow during CPR with ventricular fibrillation and (2) a new way of describing coronary perfusion effectiveness, namely, the area between the aortic and right atrial pressure curves, summed over ...

We report a 45-year-old obese uremic female, who developed sudden and profound shock followed by cardiac arrest during the percutaneous insertion of a permanently cuffed and tunneled hemodialysis catheter under local anesthesia. Upon our rush to the scene for succor, inspection revealed that she was pale, comatose, and tachypneic, while ...

INTRODUCTION: Therapeutic hypothermia after resuscitation improves outcome following prolonged out-of-hospital cardiac arrest. Laboratory studies suggest that this therapy may improve outcome further when induced during cardiopulmonary resuscitation. We report a case where therapeutic hypothermia was induced during cardiopulmonary resuscitation using large-volume (40 mL/kg), ice-cold (4 degrees C) intravenous fluid. DESIGN: ...

BACKGROUND: Noncompaction of the ventricular myocardium (NCVM) is a rare cardiomyopathy characterized by varying degrees of ventricular dysfunction and numerous, prominent trabeculations with deep intertrabecular recesses caused by arrest in myocardial embryogenesis. NCVM is rarely described in fetal and neonatal patients, and only isolated reports exist to date. METHODS: We ...

AIM OF STUDY: Interruptions in cardiopulmonary resuscitation (CPR), particularly as guided by automated external defibrillators, have been implicated in poor survival from cardiac arrest. Interruptions of CPR may be reduced by eliminating repetition of shocks between periods of CPR, elimination of the interval for patient assessment before CPR, and extension ...

Out of hospital cardiac arrest is generally managed by cardiopulmonary resuscitation (CPR) and defibrillation. The precordial thump can also be used in the initial management of witnessed cardiac arrest whilst awaiting direct current cardioversion. However, complications are associated with a precordial thump. We report a case of an out-of-hospital cardiac ...

Sudden cardiac death is a major clinical problem, causing 300,000 to 400,000 deaths annually and 63% of all cardiac deaths. Despite the overall decrease in cardiovascular mortality, the proportion of cardiovascular death from sudden cardiac death has remained constant. Survival rates among patients who have out-of-hospital cardiac arrest vary from ...

BACKGROUND: The frequency of anesthesia-related cardiac arrests during pediatric anesthesia has been reported between 1.4 and 4.6 per 10,000 anesthetics. ASA physical status >III and younger age are risk factors. Patients with congenital cardiac disease may also be at increased risk. Therefore, in this study, we evaluated the frequency of ...

After being lost for 16 hr, a 7-yr-old boy was admitted to the emergency Department (ED) in a severe hypothermic condition of 23.3 degrees C with cardiac arrest. Active rewarming was conducted with cardiopulmonary resuscitation (CPR). Sixty minutes after admission, return of spontaneous circulation was confirmed. Fever developed 14 hr ...

This study was carried out to describe the ramifications of the cardiac veins of Angora rabbit. For this purpose, a total of 16 adult healthy Angora rabbits of both sexes, 1.5-2 years of age, were used. The great, middle, right cardiac veins ran in a subepicardial course and opened into ...

We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of ...

A data set concerning cardiac arrests treated by the Emergency Medical Service in Trondheim during a nine year period is analysed. The relationship between the occurrence of cardiac arrest and covariates related to weather and season is examined. The covariate order method is used in the analysis of the data. ...

BACKGROUND: Prognosis of status epilepticus (SE) depends on its cause, but there is uncertainty as to whether SE represents an independent outcome predictor for a given etiology. Cerebral anoxia is a relatively homogenous severe encephalopathy. Postanoxic SE is associated to a nearly 100% mortality in this setting; however, it is ...

This review compiles the current knowledge of normal and abnormal myocardial morphogenesis to facilitate an unambiguous diagnosis of primary myocardial noncompaction. During the early stages of development, the formation of trabeculae with the resulting increase in myocardial surface is a adaptation of the rapidly growing heart to improve nourishment by ...

This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular ...

Human recombinant erythropoietin (rhEPO) can protect the myocardium during ischemia and reperfusion. We investigated whether rhEPO could ameliorate previously identified functional myocardial abnormalities that develop during resuscitation from cardiac arrest, using a rat model of ventricular fibrillation (VF) and closed-chest resuscitation. VF was electrically induced and maintained, untreated, for 10 ...

To investigate the effect of erythropoietin for the management of postresuscitation myocardial dysfunction following asphyxia-induced cardiac arrest. Male adult Wistar rats were used for the prospective controlled animal study. Asphyxia-induced cardiac arrest was performed by turning-off the ventilator and clamping the endotracheal tube. Cardiopulmonary resuscitation with an intravenous injection of ...

AIMS: This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. PATIENTS: All cases ...

OBJECTIVES: To develop a clinically relevant experimental model of cardiac arrest and CPR in which a partial occlusion of the left anterior descending coronary artery (LAD) is maintained during the resuscitation procedure and the initial post-resuscitation interval. MATERIALS AND METHODS: Ventricular fibrillation (VF) was induced by LAD occlusion with a ...

Because a large number of patients will suffer cardiac arrest each year, physicians must place attention on improving care for patients in the post-resuscitative setting. Part of this effort requires setting realistic goals based on patients' potential for recovery. Recovery from cardiac arrest often depends on the extent of anoxic ...

AIM: To report prospectively the outcome from prehospital cardiac arrest according to the Utstein template in the city of Tampere, Finland, with special reference to those patients in whom resuscitation was not attempted. MATERIALS AND METHODS: In Tampere (population 203,000), a two-tiered emergency medical service (EMS) system provides first response ...

AIM: The aim of the study was to investigate the frequency and type of cardiac manifestations in a defined group of patients with inborn errors of metabolism. This paper also explores the key role of cardiac manifestations in the diagnosis of inborn errors of metabolism in daily practice. METHODS: Out ...

PURPOSE OF REVIEW: Numerous recent reports have described limitations in the quality of cardiopulmonary resuscitation. Thus, there has been increasing interest in the techniques available to monitor quality. This review focuses on the major publications since the review published by the International Liaison Committee on Resuscitation in 2005. Some key ...

Mortality on liver transplantation (OLT) waiting lists has increased dramatically. Until recently, non-heart-beating donors (NHBD) were not considered suitable for OLT, because of a higher risk of primary graft nonfunction (PNF) and biliary strictures. However, recent experimental/clinical evidence has indicated that NHBD-OLT is feasible when the period of warm ischemia ...

Hypothermia has recently been shown to be beneficial in certain clinical settings of acute brain injury, such as cardiac arrest. The available technology to induce and maintain this state is advancing quickly. This review will focus on the current state of available technology and devices as well as their limitations ...

Serial left ventricular ejection fraction measurements in 23 post-cardiac arrest patients who had either ventricular fibrillation or ventricular tachycardia were analyzed to look for the occurrence of myocardial stunning. Our pilot study is the first to show trends that myocardial stunning does occur after cardiac arrest, which indicates that the ...

Cardiac arrest in foals is generally secondary to other serious systemic diseases. Although it can often be anticipated, a clear plan is vital to success. Establishing cardiac output through chest compressions is the most important first step. This step should be followed by ventilation, drug therapy, identifying the nonperfusing cardiac ...

Prolonged cardiac arrest with external chest compression was regarded as a contraindication to thrombolysis for acute myocardial infarction, although recent work has largely refuted previous concerns. This paper presents a serious haemorrhagic complication, which risked airway patency due to unrecognised nasopharyngeal airway-induced trauma and tongue biting. The patient required blood ...

The decision to terminate resuscitative measures in the setting of cardiac arrest is based on several criteria, some of which are subjective. Ultrasound in the emergency department has potentially added an objective data point to assist in this decision. We sought to determine if emergency physicians who were trained in ...

OBJECTIVE: Data are lacking on the relationship between postresuscitation ECG and outcome in out-of-hospital cardiac arrest (OHCA). We examined the prognostic information that postresuscitation ECG rhythm can provide for predicting outcome in OHCA survivors. METHODS: The retrospective observational study enrolled 56 successfully resuscitated nontraumatic adult OHCA patients. Postresuscitation 12-lead ECGs ...

BACKGROUND AND PURPOSE: Previous reports indicate that compared with normoxia, 100% ventilatory O(2) during early reperfusion after global cerebral ischemia decreases hippocampal pyruvate dehydrogenase activity and increases neuronal death. However, current standards of care after cardiac arrest encourage the use of 100% O(2) during resuscitation and for an undefined period ...

OBJECTIVES: The purpose of this retrospective study was to determine whether objective assessment of cardiac shifting on two-dimensional ultrasonography can predict postnatal outcome in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH). MATERIALS AND METHODS: Still images at the level of the four-chamber view were obtained in 23 fetuses with ...

At a recent Keystone symposium on "Molecular Pathways in Cardiac Development and Disease" in Colorado, significant advances in the understanding of heart development were discussed. The identification and isolation of cardiovascular progenitors, their modulation by secreted factors, and some tantalizing insights into cardiac regeneration were some of the highlights of ...

The duration of untreated ventricular fibrillation (VF) is of paramount importance for CPR success. Moreover, therapeutic interventions taking into account the interval between cardiac arrest onset and initiation of CPR improve outcome. This study was performed to investigate whether VF feature analysis could be used to estimate the duration of ...