Resuscitation
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Increased serum concentrations of brain-derived proteins neuron-specific enolase (NSE) and protein S-100beta (S-100b) are used as early predictors of long-term outcome in unconscious survivors after cardiopulmonary resuscitation (CPR). We investigated whether use of short-term Left Ventricular Assist Devices (LVAD) in patients undergoing percutaneous coronary intervention (PCI) effect serum concentrations of NSE and S-100b, because use of such devices in resuscitated cardiogenic shock patients increased during the last years. ⋯ LVAD support after PCI is associated with a significant increase in NSE serum concentration as well as in S-100b. We therefore postulate an overestimation of the extent of hypoxic brain damage in unconscious survivors after CPR if treatment include LVAD support or PCI or both procedures. The increase in NSE can be partly explained by alteration of thrombocytes and other blood cells. However, the increase in S-100b remains unexplained since S-100b does not occur in peripheral blood cells. An additional release of both biomarkers from ischemic myocardium or cerebral microembolism should be drawn into consideration.
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Whether the ventilator-induced lung injury (VILI) superimposed on ischemia/reperfusion injury (I/R) causes synergistic damage has not been well explored. Whether nuclear factor-kappa B (NF-kappaB) antibody has protective effects for both injuries is also unknown. ⋯ VILI and I/R cause synergistic damage on the lung. I/R or VILI alone or combined can be attenuated by NF-kappaB antibody. NF-kappaB plays an important role in both forms of lung injury. We propose anti-NF-kappaB antibody pretreatment to be beneficial for VILI, I/R and lung transplantation.
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Randomized Controlled Trial
Chest compression quality and rescuer fatigue with increased compression to ventilation ratio during single rescuer pediatric CPR.
The effects of the recommended 30:2 compression:ventilation (C:V) ratio on chest compression rate (CR), compression depth (CD), compression pressure (CP) and rescuer fatigue is unknown during pediatric CPR. We hypothesized that a 30:2 C:V ratio will decrease compression depth and compression pressure and increase rescuer fatigue compared with a 15:2 ratio. ⋯ During single rescuer pediatric BLS, more compression cycles were achieved with 30:2 C:V ratio without effect on compression depth, pressure and rate. Increased HR with 30:2 C:V ratio was noted during larger manikin CPR without subjective difference of reported fatigue. Most rescuers in AD and TF group did not achieve recommended compression depth regardless of C:V ratio.
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The prognostic implications of conversion to ventricular fibrillation (VF) in out-of-hospital cardiac arrest (OHCA) patients with an initial non-shockable rhythm are unclear. ⋯ Based on a large-scaled population-based cohort of OHCA, subsequent VF with defibrillation was associated with better outcomes among patients with an initial non-shockable rhythm.
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Hyperkalemia may cause cardiac pacemaker (PMK) malfunctioning due to a reduction of the electronegativity of the resting myocardial potential. Both sensing and capture mechanisms could be temporarily affected, with possible life-threatening effects. ⋯ She was managed with immediate i.v. calcium chloride, followed by insulin/glucose and sodium bicarbonate infusions; the ECG recordings show an almost immediate correction of the PMK malfunctioning and serial improvement of the intraventricular conduction. This case supports the feasibility and effectiveness of i.v. calcium administration, as expected on the basis of electrophysiological ionized calcium effect on the threshold potential.