Resuscitation
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We investigated an electrocardiographic signal analysis technique for predicting whether an electrical shock would reverse ventricular fibrillation (VF) in an effort to minimize the damaging effects of repetitive shocks during CPR. ⋯ AMSA predicted when an electrical shock failed to restore spontaneous circulation during CPR with a high negative predictive value. This method potentially fulfills the need for minimizing ineffective defibrillation attempts and their attendant adverse effects on the myocardium.
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To examine the epidemiology of cardiac arrest (CA) in New South Wales (NSW), Australia, and a large teaching hospital in Sydney and to identify predictors of survival. ⋯ We describe considerable variation in CA rates in NSW. The majority of hospital CAs occur at or soon after admission, and are associated with underlying non-cardiac conditions. Survival following hospital CA is low, but there may be preventable elements. Knowledge of risk factors and epidemiology of hospital CAs may help identify patients at risk of CA.
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We report the case of a 45-year-old woman who had ingested 2000 mg of flecainide with suicidal intent. She developed therapy-resistant ventricular fibrillation (VF) with cardiopulmonary arrest. Cardiopulmonary resuscitation and advanced life support were sustained for 64 min. ⋯ She recovered completely after 5 days, leaving the hospital without neurological sequelae. Serum flecainide levels approximately 5 h post-ingestion were 850 mg/l. This case report confirms the value of amiodarone in drug-resistant VF, even when the cause may be another antiarrhythmic drug such as flecainide.
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We investigated the effect of massive pulmonary embolism (MPE) on end tidal CO(2) (etCO(2)) and tested two hypotheses: (1) that etCO(2) can distinguish massive PE from hemorrhagic shock and (2) that PE with cardiac arrest reduces etCO(2) during resuscitation to a greater extent than arrhythmic cardiac arrest. ⋯ Massive PE with shock decreases the etCO(2) and increases the dead space fraction to a greater extent than hemorrhagic shock at the same MAP. Cardiac arrest from PE is associated with extremely low etCO(2) readings during CPR.
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Female C57BL/6 mice were decapitated and their brains were removed and cultured at either 37 or 33 degrees C for 48 h to investigate whether or not moderate hypothermia alters the cytokine reactions in the ischemic brain. The interleukin-6 and interleukin-1alpha levels in the culture media were significantly elevated in a time-dependent manner. The interleukin-6 levels after the incubation at 33 degrees C were significantly lower than those at 37 degrees C. ⋯ At 37 degrees C, the mRNA expression of interleukin-6 was observed from 2 to 48 h after incubation, but the same expression of interleukin-1alpha was only detected until 12 h. Accordingly, the ischemic brain incubated at 33 degrees C showed a decreased interleukin-6 production in comparison with that at 37 degrees C and the level of interleukin-6 showed negative feedback for the production of interleukin-1alpha. The temperature should, therefore, be carefully considered when evaluating the cytokine reaction for cerebral ischemia.