Articles: cardiac-arrest.
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Extracorporeal cardiopulmonary resuscitation (CPR) for refractory in-hospital cardiac arrest has been associated with improved survival compared with conventional CPR. Perioperative patients represent a unique cohort of the inpatient population. This study aims to describe and analyze the characteristics and outcomes of patients who received extracorporeal CPR for perioperative cardiac arrest. ⋯ The use of extracorporeal CPR for adults with perioperative cardiac arrest can be associated with excellent survival with neurologically favorable outcomes in carefully selected patients. Longer CPR time, higher lactate levels, and lower pH were associated with increased mortality. Given the small sample size, no other prognostic factors were identified, although certain trends were detected between survival groups.
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Mitochondrial transplantation (MTx) is an emerging strategy for restoring cellular bioenergetics and mitigating ischemia-reperfusion (IR) injury. We previously demonstrated that MTx improved neurological outcomes and survival in a rat model of cardiac arrest (CA). However, the mechanisms underlying these benefits, particularly regarding immune modulation and transcriptional regulation, remain unclear. ⋯ MTx improves outcomes after CA, accompanied by mitochondrial uptake by immune cells and redistribution to injured tissues. This process likely modulates immune responses, enhances mitochondrial fusion, and activates cytoprotective gene expression.
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Anaesth Intensive Care · Feb 2025
The impact of the introduction of monitored anaesthesia care in the cardiac catheterisation laboratory on Clinical Review, Rapid Response, and Blue Code rates, and mortality.
Most procedures in cardiac catheterisation laboratories (CCLs) have traditionally been performed under conscious sedation under the supervision of the treating proceduralist. With growing demand for more complex procedures to be performed, in emergencies and in patients with limited cardiorespiratory reserve, a reconsideration of the level of supervision provided is required. We conducted a retrospective cohort study of all patients who had CCL procedures and required an overnight stay at Royal North Shore Hospital during a 12-month period prior to introducing monitored anaesthesia care (MAC), compared with a 12-month period following introduction of MAC on selected weekdays. ⋯ We found no statistically significant difference in any of the primary or secondary outcomes between the pre-intervention and post-intervention patients overall. However, we found a statistically significant lower rate of Code Blue calls in patients who had MAC (n = 3, 0.6%) compared with no MAC (n = 31, 2.3%). We also found a significantly lower 24-h mortality in patients who had MAC (n = 1, 0.2%) compared with no MAC (n = 22, 1.6%), but no difference in overall in-hospital mortality.
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The capacity to integrate information across brain regions and sufficient diversity of neural activity is necessary for consciousness. In patients in a post-hypoxic ischemic coma, the integrity of the auditory processing network is indicative of chances of regaining consciousness. However, our understanding of how measures of integration and differentiation of auditory responses manifest across time of coma is limited. ⋯ The complexity of EEG responses was not different between patients who regained consciousness and those who did not, but it significantly diminished over time of coma, irrespective of the patient's outcome. Our findings provide novel insights on the optimal temporal window for assessing auditory functions in post-hypoxic ischemic coma. They are of particular importance for guiding the implementation of quantitative techniques for prognostication and contribute to an evolving understanding of neural functions within the acute comatose state.