Cardiac Arrest Research Articles

Epidemiology and outcomes of patients with cardiac arrest in the emergency department of a lower middle-income country

BackgroundAdvanced cardiovascular life support (ACLS) for cardiac arrest is a cornerstone of emergency care and yet remains poorly studied in low- and middle-income countries. We characterised the clinical epidemiology and...

Long-term incidence of implantable cardioverter-defibrillator therapy in patients with hypertrophic cardiomyopathy: analysis of appropriate and inappropriate interventions

BackgroundTreatment with implantable cardioverter-defibrillators (ICDs) effectively prevents sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). Identifying patients most likely to benefit from a primary prevention ICD remains challenging....

Protocol and Statistical Analysis Plan for the Randomized Trial of Sedative Choice for Intubation (RSI).

Emergency tracheal intubation is a common and high-risk procedure. Ketamine and etomidate are sedative medicines commonly used to induce anesthesia for emergency tracheal intubation, but whether the induction medication used affects patient outcomes is uncertain. Does the use of ketamine for induction of anesthesia decrease the incidence of death among adults undergoing emergency tracheal intubation, compared to the use of etomidate? The Randomized trial of Sedative choice for Intubation (RSI) is a pragmatic, multicenter, unblinded, parallel-group, randomized trial being conducted in 14 sites (6 emergency departments and 8 intensive care units) in the United States. The trial compares ketamine vs etomidate for induction of anesthesia among 2,364 critically ill adults undergoing emergency tracheal intubation. The primary outcome is all-cause, 28-day in-hospital mortality. The secondary outcome is the incidence of cardiovascular collapse during intubation, a composite of hypotension, receipt of vasopressors, and cardiac arrest. Enrollment began on April 6, 2022, and is expected to conclude in 2025. The RSI trial will provide important data on the effects of ketamine vs etomidate on death and other outcomes for critically ill adults undergoing emergency tracheal intubation. Specifying the protocol and statistical analysis plan before the conclusion of enrollment increases the rigor, reproducibility, and interpretability of the trial. ClinicalTrials.gov ; No.: NCT05277896 ; URL: www.clinicaltrials.gov. Study Question: Does use of ketamine for induction of anesthesia during emergency tracheal intubation decrease the incidence of death, compared with use of etomidate?Results: This manuscript describes the protocol and statistical analysis plan for the Randomized trial of Sedative choice for Intubation (RSI) comparing ketamine vs etomidate for induction of anesthesia for emergency tracheal intubation.Interpretation: Prespecifying the full statistical analysis plan before completion of enrollment increases rigor, reproducibility, and transparency of the trial results.

Clinical features of autonomic dysfunction in children with anti-N-methyl-D aspartic receptor encephalitis

BackgroundAnti-N-methyl-D-aspartic receptor encephalitis (Anti-NMDAR encephalitis) is the most prevalent form of autoimmune encephalitis in pediatric patients. Autonomic dysfunction is a frequent symptom of Anti-NMDAR encephalitis, yet it often goes unnoticed by pediatricians. Studies have indicated that pediatric patients with autonomic dysfunction exhibit a poorer prognosis compared to those without. To date, research on autonomic dysfunction in encephalitis has predominantly focused on adults, with no studies conducted on pediatric populations. This analysis examines the clinical features of pediatric patients with Anti-NMDAR encephalitis complicated by autonomic dysfunction.MethodsWe performed a retrospective analysis of patients diagnosed with Anti-NMDAR encephalitis at the Department of Neurology, Children’s Hospital affiliated to the Capital Institute of Pediatrics, from June 2017 to June 2023. Patients were categorized based on the presence or absence of autonomic dysfunction during their illness. We summarized and compared the clinical features of children with autonomic dysfunction and analyzed the risk factors for its development in pediatric Anti-NMDAR encephalitis patients.ResultsA total of 56 children were included in this study. Twenty-two (39.3%) exhibited autonomic nervous dysfunction. The most prevalent symptom of autonomic dysfunction was cardiovascular autonomic dysfunction(21/22, 95%),with the specific manifestations being sinus tachycardia (8 cases), ventricular premature beats (2 cases), atrioventricular block (2 cases), atrial premature beats (3 cases), and sinus bradycardia (4 cases),hypertension(1 case) and cardiac arrest(1 case). Other symptoms included gland secretion dysfunction (19/22, 86%),ventilate dysfunction(3/22,14%), thermoregulatory dysfunction (3/22,14%), bladder dysfunction(2/22,9%). Compared to the group without autonomic dysfunction, the group with dysfunction showed significantly higher rates of prodrome infection, tumor complications (all ovarian teratoma), consciousness disturbance, elevated cerebrospinal fluid protein, initiation of second-line and long-term immunotherapy, length of hospital stay, and hospitalization costs (P < 0.05).ConclusionAmong pediatric patients with Anti-NMDAR encephalitis, cardiovascular autonomic dysfunction is the most common form of autonomic dysfunction. Those with autonomic dysfunction have a worse prognosis and longer hospital stays. Active initiation of second-line and long-term immunotherapy is recommended.

Sudden Cardiac Arrest Associated with Hemodialysis: A Community-Based Study.

Individuals with end-stage renal disease may be at increased risk of sudden cardiac arrest (SCA) associated with dialysis therapy. However, community-based studies with comprehensive adjudication of SCA are lacking. We conducted a community-based study using a case-case study design in a US population of ≈1 million. All SCA cases with chronic kidney disease (CKD) were ascertained prospectively (2002-2020). We reviewed EMS narratives and archived medical records from regional hospitals to capture patients dialysis history, schedules, and the timing of SCA events in relation to dialysis sessions. Among those on regular hemodialysis, individuals who suffered SCA during hemodialysis or within an hour after completing hemodialysis (Intradialytic/immediate post-HD [IIHD]) were compared to cases with SCA at other times (non-IIHD). Non-compliant individuals or those intolerant of dialysis were excluded. Out of 1,023 SCA cases with CKD, 195 (19.1%) were undergoing regular scheduled hemodialysis. Among these cases, 24.1% were IIHD SCA, while 75.9% occurred non-IIHD. The incidence of SCA during dialysis was 2.9 times higher than expected by chance. SCA events were more likely to occur on dialysis days (65.3% of events) vs. 34.7% events on the 4 off dialysis days (p<0.001). IIHD SCA had higher serum sodium (138.9±4.8 vs. 135.5±5.5 mmol/L, p=0.005), lower serum potassium (3.6±0.7 vs. 5.6±1.6 mmol/L, p<0.001), and higher bicarbonate levels (25.9±6.6 vs. 20.2±5.5 mmol/L, p<0.001) compared to their non-IIHD SCA counterparts. Regarding resuscitation details, IIHD SCA had a higher percentage of shockable rhythm (46.5 vs. 32.4%, p=0.09), witnessed collapse (85.1 vs. 53.4%, p<0.001), bystander CPR (72.3 vs. 37.9%, p<0.001), return of spontaneous circulation (66.0 vs. 42.5%, p=0.005), and survival to hospital discharge (30.4 vs. 5.4%, p<0.001) compared to non-IIHD SCA. In patients undergoing dialysis, SCA events were significantly more common on dialysis days, and 3-fold higher than expected by chance. We identified potential risk factors and survival outcome differences between IIHD vs. non-IIHD SCA groups that warrant future investigation.

Socioeconomic position and sudden cardiac death: A Danish nationwide study.

The aim of this study was to examine differences in incidence rates of all-cause mortality (ACM) and sudden cardiac death (SCD) in persons of differing socioeconomic position (SEP). All deaths in Denmark from 01-01-2010 to 31-12-2010 (1 year) were included. Autopsy reports, death certificates, discharge summaries and nationwide health registries were reviewed to identify cases of SCD. SEP was measured as either household income or highest achieved educational level and analysed separately. Hazard rates were calculated using univariate and multivariable Cox regression model adjusting for age, sex, and selected comorbidities. A total of 53452 deaths were included of which 6820 were classified as SCDs. Incidence rates of ACM and SCD increased with age and were higher in the lower SEP groups. The greatest difference in SCD incidence was found between the low and high education level groups with an incidence rate ratio of 5.1 (95% CI 3.8-6.8). The hazard ratios for ACM and SCD were significantly higher for low SEP groups independently of comorbidities. Compared with the highest income group, the low-income group had adjusted hazard ratios of ACM and SCD that were 2.17 (2.01-2.34) and 1.72 (1.67-1.76) respectively. We observed an inverse association between both income and education level and the risk of ACM and SCD in the general population, which persisted independently of baseline comorbidities. Our results indicate a need for further research into the mechanisms behind socioeconomic disparities in healthcare and targeted preventative strategies.

A CASE OF INTRAOPERATIVE ARREST &amp; MOBILE ECMO

Over the past two decades, extracorporeal membrane oxygenation (ECMO) has been increasingly used to support critical patients with cardiac and respiratory failure who fail to respond to conventional management. In refractory cardiac arrest, ECMO can restore perfusion in patients who meet specific criteria designed to maximize survival benefit and good neurological outcomes. In recent literature, there is no report of mobile ECMO in a case of prolonged cardiac arrest with direct cardiac massage. We describe our experience with a 34-year-old man with multiple traumatic injuries following a motor vehicle collision. He was treated in a trauma center hospital in the same city as our center. He was initially in stable condition (spontaneous ventilation with FiO2 0.21, no vasoactive drugs, Glasgow 15, no acute kidney injury or other organ dysfunction). One week after admission, a retained left hemopneumothorax required surgical intervention, as previous drainage was ineffective. Computed tomography imaging was also concerning for parencyhmal injury by the thoracotomy tube. Intraoperatively, when the patient was placed in lateral position, he experienced cardiac arrest, presumed to be secondary to pulmonary embolism. After 18 minutes we were asked to rescue this patient with ECMO, as he had no contraindications to support. After 81 minutes of advanced life support, including direct cardiac massage, return of spontaneous circulation was achieved seconds after ECMO was initiated. He was then transported to our hospital. The patient achieved a favorable neurological outcome (Glasgow Coma Scale score of 15 at 24 h) and was discharged after a 2 month stay. This case highlights the potential benefits of prolonged cardiopulmonary resuscitation and ECMO in patients with refractory in-hospital cardiac arrest. In this case, proper ACLS and CPR allowed time for mobile ECMO support to be initiated from a remote center.

Personalized neuron-specific enolase level based on EEG pattern for prediction of poor outcome after cardiac arrest

BackgroundAfter cardiac arrest (CA), the European recommendations suggest to use a neuron-specific enolase (NSE) level > 60 µg/L at 48–72 h to predict poor outcome. However, the prognostic performance of NSE can vary depending on electroencephalogram (EEG). The objective was to determine whether the NSE threshold which predicts poor outcome varies according to EEG patterns and the effect of electrographic seizures on NSE level.MethodsA retrospective study was conducted in a tertiary CA center, using a prospective registry of 155 adult patients comatose 72 h after CA. EEG patterns were classified according to the Westhall classification (benign, malignant or highly malignant). Neurological outcome was evaluated using the CPC scale at 3 months (CPC 3–5 defining a poor outcome).ResultsParticipants were 64 years old (IQR [53; 72,5]), and 74% were male. 83% were out-of-hospital CA and 48% were initial shockable rhythm. Electrographic seizures were observed in 5% and 8% of good and poor outcome patients, respectively (p = 0.50). NSE blood levels were significantly lower in the good outcome (median 20 µg/L IQR [15; 30]) compared to poor outcome group (median 110 µg/l IQR [49;308], p < 0,001). Benign EEG was associated with lower level of NSE compared to malignant and highly malignant patterns (p < 0.001). The NSE level was not significantly increased in patients with seizures as compared with malignant patterns (p = 0.15). In patients with a malignant EEG, a NSE > 45.2 µg/L was predictive of unfavorable outcome with 100% specificity and a higher sensitivity (70.8%) compared to the recommended NSE cut-off of 60 µg/l (Se = 66%). Combined to electrographic seizures, a NSE > 53.5 µg/L predicts poor outcome with 100% specificity and a higher sensitivity (77.7%) compared to the recommended cut-off (Se = 66.6%). Combined to a benign EEG, a NSE level > 78.2 µg/L was highly predictive of a poor outcome with a higher specificity (Sp = 100%) compared to the recommended cut-off (Sp = 94%).ConclusionIn comatose patients after AC, a personalized approach of NSE according to EEG pattern could improve the specificity and sensitivity of this biomarker for poor outcome prediction. Compared to others malignant EEG, no significant difference of NSE level was observed in case of electrographic seizures.

Incidence and predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock.

This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS). Overall, 685 patients with CS treated with VA-ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49-66] years, 542 [79.1%] male, median lactate 7.6 [interquartile range 4.1-12.7] mmol/L). The cause of CS was acute myocardial infarction in 438 (63.9%) patients, and 431 (62.9%) patients presented with cardiac arrest. A total of 410 patients (59.9%) were successfully weaned from VA-ECMO, whereas in 275 patients (40.1%) weaning failed (i.e. patients died on or within 48 h after VA-ECMO support). Of the successfully weaned patients, 150 (36.6%) died before hospital discharge. On multivariable logistic regression, predictors for both patient groups varied: age (per 10 years, odds ratio [OR] 1.49, 95% confidence interval [CI] 1.25-1.76; p < 0.001) and cardiac arrest before VA-ECMO implantation (OR 1.64, 95% CI 1.01-2.64; p = 0.04) were associated with weaning failure, whereas lactate clearance within 24 h after VA-ECMO initiation was associated with successful weaning (OR 0.21, 95% CI 0.1-0.44; p < 0.001). In-hospital death after successful weaning was more likely with higher age (per 10 years, OR 1.56, 95% CI 1.24-1.97; p < 0.001), renal replacement therapy (OR 2.56, 95% CI 1.4-4.68; p = 0.002) and bleeding events (OR 2.93, 95% CI 1.4-6.14; p = 0.004). Weaning from VA-ECMO fails in 40% of patients treated with VA-ECMO for CS. When successful, survival after VA-ECMO weaning mostly depends on age and the incidence of device- and shock-related complications.

Mortality Patterns in Pediatric Pulmonary Vein Stenosis: Insights Into Right Ventricular Systolic Pressure Associations.

Pulmonary vein stenosis in children is associated with a poor prognosis. However, the cause and risk factors for mortality remain uncertain. This retrospective, single-center study identified children with primary and secondary pulmonary vein stenosis through a cardiac catheterization database. Kaplan-Meier analysis, log-rank tests, and Cox regression analysis were performed to assess outcome and identify significant predictors of mortality. Among 56 children with pulmonary vein stenosis (33 male children, 59%), 20 (36%) died at a median age of 10 months (interquartile range,4-24 months). All patients underwent cardiac catheterization, with 45 (80%) undergoing at least 1 interventional procedure. Causes of death included multiorgan failure (35%), progressive respiratory failure (20%), and sudden cardiac death (15%). Prematurity, chronic lung disease, a genetic syndrome, or the number of affected pulmonary veins did not significantly correlate with mortality. However, right ventricular (RV) systolic pressure greater than half systemic pressure was associated with mortality (hazard ratio [HR], 5.5 [95% CI, 2.2-14.1]; P<0.001). The final predictive model for mortality included RV systolic pressure greater than half systemic pressure (HR, 4.0 [95% CI, 1.6-10.4]; P=0.004), moderately or severely diminished RV systolic function (HR, 3.6 [95% CI, 1.1-11.5]; P=0.032), and the presence of congenital heart disease (HR, 2.4 [95% CI, 0.9-6.7]; P=0.084). This report is the first to indicate that RV systolic pressure and RV dysfunction are significant independent predictors of mortality in children with pulmonary vein stenosis. A greater understanding of mortality in this population is necessary, particularly in those with RV systolic pressure less than half systemic.

Cardiac Critical Care of the Cardio-Obstetric Patient.

Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States, with an incidence that has increased from 7.2 to 32.9 fatalities per 100,000 live births in the last 3 decades. This trend underscores the potential for an increase in the volume of admissions to cardiac intensive care units (CICUs) in the peripartum period. While congestive heart failure remains at the forefront of maternal morbidity, other life-threatening conditions include myocardial infarction (MI), hypertensive emergencies, fatal arrhythmias such as ventricular fibrillation, venous thromboembolism, aortopathies, valvular dysfunction, cardiac arrest, and cardiogenic shock. The lack of standardized guidelines to facilitate management of these conditions highlights the significant gap in medical knowledge while caring for acutely ill pregnant women. Through this comprehensive review, we highlight the most common cardiac pathologies encountered in the obstetric population and their diagnosis and contemporary management in the cardiac intensive care unit.

Effectiveness of a blended (distance and in-person) simulation education program on advanced cardiac life support for nursing students using the PARTNER model

BackgroundThe incidence of acute cardiac arrest is increasing and is directly linked to patient survival, highlighting the critical role of nurses. Advanced nursing skills for cardiac arrest patients, such as self-directed pre-learning applied to various clinical situations, require a systematic blended learning approach to integrate knowledge and enhance clinical performance through face-to-face practice. The purpose of this study is to evaluate the effectiveness of a blended simulation education program for Advanced Cardiac Life Support (ACLS) using the PARTNER model.MethodsA nonequivalent control group pretest-posttest design with a time-lagged approach was used to collect data from 34 third-year nursing students. The experimental group(n = 17) received a 480-minute blended simulation education program based on the PARTNER model and flipped learning, while the control group(n = 17) participated in a 480-minute traditional simulation education program.ResultsThe study found that knowledge, confidence, performance in advanced cardiac life support, and clinical performance ability were effectively enhanced, although no significant effect was observed in learning satisfaction.ConclusionsThe program provides a new direction in applying blended simulation using the PARTNER model for advanced cardiac life support nursing education, ultimately contributing to the training of nurses competent in advanced cardiac life support.

The Correlation Between the Type of Fluid Administration and the Incidence of Hypotension in Patients Undergoing Spinal Anesthesia at RS Wijayakusuma Purwokerto

Background: Spinal anesthesia is a type of regional anesthesia that involves injecting a local anesthetic into the subarachnoid area. The effect of sympathetic blockade in spinal anesthesia can cause dilation of blood vessels, suppress systemic vascular resistance and result in hypotension [1]. The effects of hypotension are pulmonary aspiration, cardiac arrest, respiratory depression, and loss of consciousness. A sudden drop in blood pressure can also cause a heart attack, a complication of spinal anesthesia. Method: A quantitative approach using a correlational observational design with research variables, namely the administration of fluid types with the incidence of hypotension in patients undergoing spinal anesthesia. The research was conducted in the IBS room at Wijayakusuma Hospital, Purwokerto, with samples was calculated obtained 53 respondents who were selected using a purposive sampling technique. The relationship between the two variables tested was carried out using the non-parametric chi square statistical test with the Fisher exact test Results: Among the respondents, the type of fluid administered was crystalloids in 98.1% of cases, with 70.2% of respondents not experiencing hypotension. The chi-square test yielded a p-value of 1.000, indicating no significant correlation between the type of fluid administered and the incidence of hypotension in patients undergoing spinal anesthesia. Conclusion: There is no significant correlation between the administration of crystalloid or colloid fluids and the incidence of hypotension in patients undergoing spinal anesthesia at RST Wijayakusuma Purwokerto.

Nourishment of nerves and innervation: A novel approach for the treatment of myocardial infarction.

Autonomic innervation of the heart plays a pivotal role not only in regulating the heart rate but also in modulating the cardiac cell microenvironment via cell-cell interactions and influencing the heart's repair capabilities. Currently, the primary clinical approach for treating myocardial infarction (MI) is percutaneous coronary intervention. However, the myocardial salvage rate remains low for patients with advanced disease. MI is recognized as an autonomic nervous system disorder, marked by sympathetic hyperactivity and the loss of parasympathetic nerves. Following MI, ventricular sympathetic nerve sprouting occurs, leading to an increase in ventricular sympathetic innervation and, consequently, an increased risk of ventricular arrhythmia, which is the primary cause of sudden cardiac death in patients with a history of MI. The vagus nerve positively regulates cardiomyocyte proliferation and regeneration, enhancing ventricular remodeling and cardiac function post-MI. This process is highly significant in the treatment and rehabilitation of MI. Cardiac autonomic nerves are influenced by factors such as inflammation, immunity, intercellular communication, metabolism, genetics, epigenetics, and cytokine secretion related to cardiac mesenchymal nerves. In recent years, significant advancements have been made regarding treatment for MI, specifically in the fields of autonomic nervous system therapies, stem cell and extracellular vesicle treatments, traditional Chinese medicine acupuncture and moxibustion, and peripheral electrophysiological stimulation and bioengineering materials. The balance of dominance between the sympathetic and parasympathetic nervous systems in the heart affects tissue regeneration and cardiac remodeling after MI. The secretion of neurons regulates the microenvironment of cardiac repair. The neural therapy of MI involves multiple fields such as traditional Chinese medicine, biomaterials, stem cell therapy, and drug research and development, and has broad development prospects Key Messages: The regulation exerted by the cardiac autonomic nervous system on the heart significantly influences the prognosis of MI. This involves nervous system modulation of inflammation and heart rate and complex interactions between neurons and cardiomyocytes, immune cells, fibroblasts, adipocytes, stem cells, and other cellular components. Genetic and epigenetic modifications, as well as shifts in energy metabolism, also play crucial roles.

Cardiopulmonary bypass with deep hypothermic circulatory arrest results in organ-specific transcriptomic responses in pediatric swine.

The organ-level molecular response to cardiac surgery with cardiopulmonary bypass (CPB) remains inadequately understood and may be heterogeneous. Here, we measured organ-specific gene expression in a piglet model of CPB with deep hypothermic circulatory arrest (DHCA). Infant piglets underwent peripheral CPB with 75min of DHCA and 6h of critical care after separation from CPB. Mechanically ventilated animals served as controls. Tissue was obtained from the lung, kidney, liver, heart, and ileum. RNA sequencing was performed using NovaSeq 6000 and evaluated via differentially expressed gene (DEG) and pathway/network analyses. CPB/DHCA induced significant transcriptomic alterations, with greater changes seen in liver (2,192 DEGs), heart (777 DEGs), and kidney (1,774 DEGs) compared to lung (410 DEGs) and ileum (11 DEGs), and little overlap across organs (<20% differentially expressed in >1 organ). Key upregulated systems included ribosomal proliferation and mitochondrial assembly in the liver, oxidative stress response and proximal tubular repair in the kidney, myofilament structural genes and pro-hypertrophy pathways in the heart, and solute channels and arginine metabolism in the lung. Downregulation of adaptive immunity genes occurred in multiple organs. Transcriptomics could inform the investigation of targeted therapies and adverse event screening after cardiac surgery.

Predictive Factors for 24-h Survival After Perioperative Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort Study.

Background: Perioperative cardiac arrest (POCA) remains a major challenge in surgical settings, with low survival after cardiopulmonary resuscitation (CPR). This study aims to identify predictive factors for 24 h survival after CPR and cause of POCA. Method: A retrospective, single-center study was conducted on patients aged ≥18 years who experienced POCA and received CPR in the operating room or within 2 h postoperatively at Chiang Mai University Hospital from 2010 to 2019. The multivariable analysis of independent survival predictors was performed using risk regression models. Results: There were 288 cases of cardiopulmonary arrest requiring CPR, with 61 patients surviving. Significant predictors of survival after perioperative CPR included the American Society of Anesthesiologists physical status classification (ASA) 1-2 (RR 2.53; 95%CI 1.69-3.77; p < 0.001), preoperative hemoglobin ≥ 8 g/dL (RR 2.27; 95%CI 1.05-4.89; p = 0.036), preoperative oxygen saturation ≥ 90% (spontaneous breathing in room air) (RR 3.19; 95%CI 1.21-8.41; p = 0.019), initial end-tidal carbon dioxide between 35 and 45 mmHg (RR 1.55; 95%CI 0.98-2.44; p = 0.059), and duration of CPR ≤ 30 min (RR 3.68; 95%CI 1.51-8.98; p = 0.004). The major cause of POCA was hypovolemia (74.30%). Conclusions: This study identifies several critical predictors for 24 h survival following POCA, which can inform pre-operative optimization and perioperative management. Timely interventions, such as blood transfusions and volume resuscitation, are crucial in improving survival outcomes, particularly in trauma and high-risk patients. Further multi-center studies are needed to validate these findings and explore long-term outcomes to refine perioperative cardiac arrest management.

Exploring effects of a booster workshop on progression and retention of resuscitation skills of residents when added to regular low-dose simulation

BackgroundImproving the resuscitation and teamwork skills of residents is key to better outcomes of in-hospital cardiac arrest events. This study aims to explore the effects of regular low-dose simulation combined with a booster workshop on the progression and retention of resuscitation skills and teamwork among residents.MethodsThis comparative study took place at a teaching hospital in Northern Taiwan from August 2019 to June 2021. Residents were divided into two groups: the control group received regular low-dose simulation with faculty-led debriefing at the 1st, 6th, and 11th months, while the intervention group participated in an additional 3-hour simulation workshop one week before the 6th-month scenario. The workshop focused on resuscitation and teamwork skills. The study evaluated medical task performance, teamwork, patient safety attitudes, and timing of key resuscitation actions through standardized simulation scenarios, with the assessments occurring at the 1st, 6th, and 11th months (pre-test, mid-test, post-test, respectively).ResultsOutcome measures in medical task performance and team leader behavior showed statistically significant improvement in both groups (p < 0.05) from pre-test to mid-test. After the intervention, the exposure group demonstrated significantly better results in medical task performance, team leader behavior, patient safety attitudes, and the timing of chest compression initiation compared to the control group (p < 0.05). Five months after the intervention, a significant decline in most measured outcomes was observed in the exposure group (p < 0.05). Despite this decline, the exposure group still performed significantly higher than the control group across most measured outcomes.ConclusionsThis study demonstrates the potential and advantages of integrating simulation-based training into the clinical training curriculum for residents to improve medical task performance and teamwork behaviors for handling in-hospital cardiac arrest scenarios. The observed decline in skills over time supports the inclusion of regular refresher courses to maintain and advance these vital competencies.

Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement.

Right ventricular (RV) pacing exacerbates heart failure and increases cardiac mortality in patients with reduced ejection fraction (EF). However, its impact on left ventricular dysfunction in patients with preserved EF remains inconclusive. This study investigates the relationship between RV pacing, global longitudinal strain (GLS), and EF in patients with preserved EF. This prospective registry study included patients with preserved EF (≥50%) undergoing de novo permanent pacemaker (PPM) implantation for atrioventricular block at Chosun University Hospital, South Korea, from 2018 to 2022. Echocardiographic evaluations were performed pre-implant, post-implant, and at 12 months, with follow-up visits every 3-6 months. Composite outcomes included cardiac death, heart failure hospitalization, pacing-induced cardiomyopathy (PICM), and biventricular pacing (BVP) upgrade. A total of 71 patients (28 males, mean age 73.1 years) were included. Following PPM implantation, significant declines in both EF and GLS were noted, especially in those with PICM. Over three years, 2 patients died, 6 were hospitalized, 7 developed PICM, and 3 underwent a BVP upgrade. Reduced post-implant GLS was an independent predictor of PICM (hazard ratios (HR) 1.715, 95% CI 1.174-2.504; p = 0.005). Receiver operating characteristic (ROC) analysis showed an area under curve (AUC) of 0.92 for GLS, with a GLS <-15.0 having 100% sensitivity and 80.9% specificity for predicting PICM. Post-implant GLS is a reliable predictor of PICM in patients with preserved EF. Regular GLS monitoring can guide timely interventions, including guideline-directed medical therapy or BVP upgrades, to prevent deterioration and improve outcomes.

Diastolic Dysfunction and Survival in Patients with Preserved or Mildly Reduced Left Ventricular Ejection Fraction following Myocardial Infarction.

Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (>40%) following myocardial infarction (MI). This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting long-term all-cause and cardiac mortality in patients with a first-ever MI and LVEF>40%. A retrospective single centre study involving 2234 patients with a first-ever MI (STEMI or NSTEMI) with LVEF>40% was performed. Clinical, angiographic, echocardiographic and outcomes data were obtained from prospectively maintained institutional and state-wide databases. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined was grade 2&3 diastolic dysfunction. The mean age of patients was 61.4+12.3 years, 70.7% were males, and 12.1% had 3-vessel disease. The mean LVEF was 55.8+7.2% and 14.1% had significant DD. At a median follow up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional-hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (HR 2.01, 95%CI 1.37-2.94, p<0.001) and cardiac (HR 3.97, 95%CI 1.98-7.99, p<0.001) mortality. Bootstrapping and calculation of Harrel's C confirmed the independent association of significant DD with outcomes. Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively re-classifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.

Comparison of long-term outcomes of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for left main disease.

Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs. A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs. The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group. The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.