Resuscitation
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To investigate the effect of therapeutic hypothermia in the prognostic value of the pituitary-adrenal axis in comatose patients after cardiac arrest. ⋯ In comatose patients resuscitated from cardiac arrest, the pituitary-adrenal axis is activated particularly in those dying in the ICU, irrespective of therapeutic hypothermia. Hence, activation of the axis may be a marker of fatal cerebral damage. There is no firm evidence for relative adrenal insufficiency associated with death and a transiently blunted cortisol response to ACTH in non-survivors may be attributed to higher baseline values.
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We investigated the effect of electroconvulsive stimulation (ECS) on cerebral circulation in vivo using the method for measuring microcirculation in real time with the photosensitizer dye Photosense and the fiber optic spectrofluorometer LESA-01-BIOSPEC. We have found that electroconvulsive stimulation significantly improved cerebral microcirculation (fourfold higher comparing to the control cerebral perfusion) after 30 min of room-temperature cardiac arrest. Morphologic study of the brain tissue showed the absence of rouleaux formation of erythrocytes ("sludged blood") in the cerebral cortex microcirculation after the application of electrical stimulus. Electroconvulsive stimulation may be useful for improving cerebral microcirculation (blood flow) in cases of long-term brain hypoxia/anoxia after prolonged cardiac arrest.
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We have observed consistent hemodynamic patterns after restoration of spontaneous circulation (ROSC) after ventricular fibrillation (VF) cardiac arrest. We sought to characterize the time-course of these patterns, and to determine whether these differed based on duration of the VF insult. ⋯ There are two distinct phases of hemodynamic change after resuscitation of VF. The first phase is a brief hyperdynamic phase. The second phase is either stabilization or cardiovascular collapse. When VF is brief, blood pressures often return to normal without exogenous support. When VF was prolonged animals were rescued with exogenous pressor. Healthcare providers should be prepared to provide pressor support for patients having ROSC after prolonged VF.
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Automated external defibrillators (AEDs) operated by lay persons are used in the UK in a National Defibrillator Programme promoting public access defibrillation (PAD). ⋯ PAD is a highly effective strategy for patients with sudden cardiac arrest due to ventricular fibrillation who arrest in public places where AEDs are installed. Community responders who travel with an AED are less effective, but offer some prospect of resuscitation for many patients who would otherwise receive no treatment. Both strategies merit continuing development.
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Hypothermia improves outcomes after cardiac arrest (CA), while hyperthermia worsens injury. EEG recovers through periodic bursting from isoelectricity after CA, the duration of which is associated with outcome in normothermia. We quantified burst frequency to study the effect of temperature on early EEG recovery after CA. ⋯ In normothermic rats resuscitated from CA, early EEG burst frequency is strongly associated with neurological recovery. Increased bursting followed by earlier restitution of continuous EEG activity with hypothermia may represent enhanced recovery, while heightened metabolic rate and worsening secondary injury is likely in the hyperthermia group. These factors may confound use of early burst frequency for outcome prediction.