Resuscitation
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Case Reports
Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault.
The development of handheld, portable ultrasound devices has enabled the use of this diagnostic tool also in the out-of-hospital environment. We report on a pregnant teenager who was found haemodynamically unstable after a stab assault. When she suffered cardiac arrest shortly thereafter, diagnosis of cardiac tamponade was made by portable ultrasound, and immediate pericardiocentesis was performed by the emergency physician. While her baby died after emergency Caesarean section, the teenager survived after thoracotomy and prolonged resuscitation without neurological sequelae.
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Most survivors of out-of-hospital cardiac arrest (OHCA) will die subsequently from post-anoxic encephalopathy. In animals, the severity of brain damage is mainly influenced by the duration of cardiac arrest and also by the cerebral blood flow (CBF) and oxygen extraction (CEO2) abnormalities observed during the post-resuscitation period. The aim of our study was to describe CBF and CEO2 modifications during the first 72 h in OHCA patients treated by induced mild hypothermia. ⋯ Cerebral haemodynamic and oxygenation values are altered considerably but evolve during the first 72 h following resuscitation after cardiac arrest. In particular, these changes may lead to a mismatch between CBF and CEO2 leading to a "luxurous perfusion" in non-survivors.
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Mild hypothermia (32-35 degrees C) impairs primary haemostasis and coagulation. Correction of these haemostatic impairments by rewarming alone may not be possible or desirable, particularly in major trauma, neuroanaesthesia and in critically ill patients. Pharmacological treatment of these impairments, if available, may be a useful alternative. Desmopressin has been used to treat various congenital and acquired platelet disorders, but its effects on hypothermia-induced impairment of primary haemostasis is not known. This study aims to investigate the in vitro effects of desmopressin on hypothermia-induced impairment of primary haemostasis using PFA-100 platelet function analyzer. ⋯ Desmopressin partially reverses hypothermia-induced impairment of primary haemostasis in vitro, and may be potentially useful in improving haemostasis in hypothermic patients with bleeding where immediate rewarming is difficult or undesirable.
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To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. ⋯ The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.
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The P450 eicosanoids epoxyeicosatrienoic acids (EETs) are produced by cytochrome P450 arachidonic acid epoxygenases and metabolized through multiple pathways, including soluble epoxide hydrolase (sEH). Pharmacological inhibition and gene deletion of sEH protect against ischemia/reperfusion injury in brain and heart, and against hypertension-related end-organ damage in kidney. We tested the hypothesis that sEH gene deletion improves survival, recovery of renal function and pathologic ischemic renal damage following transient whole-body ischemia induced by cardiac arrest (CA) and resuscitation. ⋯ Unexpectedly, survival in sEHKO mice was significantly lower than WT. Only 56% of sEHKO mice survived for 10 min (n=15, p=0.014 compared to WT) and no mice survived for 24 h after CA/CPR (p<0.0001 versus WT). We conclude that sEH plays an important role in cardiovascular regulation, and that reduced sEH levels or function reduces survival from cardiac arrest.