Cardiopulmonary Performance Research Articles

Monitoring of strength, inflammation and muscle function in allogenic stem-cell transplantation patients - a pilot study for novel biomarker and risk stratification determination.

Low aerobic capacity is associated with an increased mortality risk in allogenic stem-cell transplantation (alloSCT) patients, but currently used risk scores in the pre-transplantation workup are still underestimating physical activity as a prognostic factor. To examine the physical condition, muscle function, blood inflammation and training adherence of alloSCT patients during inpatient time to identify potential biomarkers associated with development of myopathy and sarcopenia. Patients undergoing alloSCT were examined at four time points (T0: before alloSCT; Tha: hospital admission; T1: engraftment; T2: inpatient discharge). T0 included cardiopulmonary performance, body composition, grip and knee strength, motor skill tests (One-leg stand/Tinetti/Chair-rising), blood sampling (blood cell profiling and inflammation targets (Kynurenin/high sensitivity C-reactive Protein (hsCRP)/Tumor necrosis factor alpha (TNF-alpha)/Musclin/Galectin-3) and quality of life, state of health, fatigue, muscle weakness and physical activity by questionnaires (IPAQ/BSA/SARC-F/Fatigue). At T1 and T2, blood samples, grip strength and motor skill tests were repeated. Glucocorticoid dose and daily physical activity were documented during inpatient stay. 26 of 35 included patients (4 females; age 55.58 ± 12.32 years; BMI 24.70 ± 3.27 kg/m2; VO2peak 16.55 ± 4.06 ml/min/kg) could proceed to alloSCT. Grip strength and Tinetti decreased from T0 until T2, no difference in Chair-rising test, One-leg and Tandem stand. All patients engrafted after 24.9 days ± 3.9 days. HsCRP and Kynurenine increased from T0 to T1, decreased at T2. TNF-alpha (T0vsT2/T1vsT2) and Musclin (T0vsT1) decreased. At T2, Galectin-3 was higher compared to T0/T1. Correlation analysis of grip strength and inflammatory markers revealed a positive correlation with TNF-alpha at T2. 50% of patients documented physical activity and questionnaire and reported a 50%-reduction of daily endurance and strength training between T1 to T2. Allogeneic stem-cell transplantation is associated with immune system vulnerability due to conditioning, increased inflammation and fatigue, and loss of muscle strength and function. In addition to hsCRP, Kynurenine seems to be a reliable biomarker to monitor acute and regenerative inflammation status of alloSCT patients, while Musclin and Galectin-3 may be added to physiological assessment regarding myopathy and sarcopenia. Grip strength and daily activity level should be documented by professionals to identify risk patients early and support them with optimal (exercise) therapy.

Effects of wearing different face masks on cardiopulmonary performance at rest and exercise in a partially double-blinded randomized cross-over study

The use of face masks became mandatory during SARS-CoV-2 pandemic. Wearing masks may lead to complaints about laboured breathing and stress. The influence of different masks on cardiopulmonary performance was investigated in a partially double-blinded randomized cross-over design. Forty subjects (19–65 years) underwent body plethysmography, ergometry, cardiopulmonary exercise test and a 4-h wearing period without a mask, with a surgical mask (SM), a community mask (CM), and an FFP2 respirator (FFP2). Cardiopulmonary, physical, capnometric, and blood gas related parameters were recorded. Breathing resistance and work of breathing were significantly increased while wearing a mask. During exercise the increase in minute ventilation tended to be lower and breathing time was significantly longer with mask than without mask. Wearing a mask caused significant minimal decreases in blood oxygen pressure, oxygen saturation, an initial increase in blood and inspiratory carbon dioxide pressure, and a higher perceived physical exertion and temperature and humidity behind the mask under very heavy exercise. All effects were stronger when wearing an FFP2. Wearing face masks at rest and under exercise, changed breathing patterns in the sense of physiological compensation without representing a health risk. Wearing a mask for 4-h during light work had no effect on blood gases.

(537) Differences in Cardiopulmonary Exercise Performance Between True Anemia and Hemodilution in Patients with Advanced Heart Failure

(537) Differences in Cardiopulmonary Exercise Performance Between True Anemia and Hemodilution in Patients with Advanced Heart Failure

(532) Relationship Between Blood Volume Measures and Cardiopulmonary Exercise Testing Performance in Advanced Heart Failure

(532) Relationship Between Blood Volume Measures and Cardiopulmonary Exercise Testing Performance in Advanced Heart Failure

Post covid lung fibrosis (PCLF) or post covid lung sequelae (PCLS) in treated case of severe COVID-19 Pneumonia case in Intensive care unit with ventilatory support and home oxygen therapy for twelve weeks

Lung fibrosis is final radiological outcome of COVID-19 pneumonia documented in proportionately majority of cases. Post COVID lung fibrosis is considered as worrisome radiological complication observed during early phase of pandemic. Time trends of final radiological outcome has evolved over months with or without treatment with antifibrotics and steroids. Importantly, Post covid lung fibrosis resolved more than fifty percent cases in six months and nearly in all cases after one year. In this case report we have documented PCLF in 32-year male hospitalized for severe COVID-19 illness with acute hypoxic respiratory failure secondary to ARDS (acute respiratory distress syndrome). He required high flow nasal canula oxygen supplementation with noninvasive ventilatory support for three weeks. He responded to medical treatment such as injection remdesivir, methylprednisolone and low molecular weight heparin injection. He was discharged to home with advice for home oxygen therapy and medicines such as steroids and antifibrotics Nintedanib. He required oxygen for twelve weeks. His chest imaging done at one year shown residual post covid sequel without any cardiopulmonary and exercise performance impact.

Monaural cardiopulmonary sound separation via complex-valued deep autoencoder and cyclostationarity

Objective. Cardiopulmonary auscultation is promising to get smart due to the emerging of electronic stethoscopes. Cardiac and lung sounds often appear mixed at both time and frequency domain, hence deteriorating the auscultation quality and the further diagnosis performance. The conventional cardiopulmonary sound separation methods may be challenged by the diversity in cardiac/lung sounds. In this study, the data-driven feature learning advantage of deep autoencoder and the common quasi-cyclostationarity characteristic are exploited for monaural separation. Approach. Different from most of the existing separation methods that only handle the amplitude of short-time Fourier transform (STFT) spectrum, a complex-valued U-net (CUnet) with deep autoencoder structure, is built to fully exploit both the amplitude and phase information. As a common characteristic of cardiopulmonary sounds, quasi-cyclostationarity of cardiac sound is involved in the loss function for training. Main results. In experiments to separate cardiac/lung sounds for heart valve disorder auscultation, the averaged achieved signal distortion ratio (SDR), signal interference ratio (SIR), and signal artifact ratio (SAR) in cardiac sounds are 7.84 dB, 21.72 dB, and 8.06 dB, respectively. The detection accuracy of aortic stenosis can be raised from 92.21% to 97.90%. Significance. The proposed method can promote the cardiopulmonary sound separation performance, and may improve the detection accuracy for cardiopulmonary diseases.

Cardiopulmonary exercise testing for exercise prescription in cardiac rehabilitation

Aerobic endurance training is acore component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, adetailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO2) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO2 and determination of ventilatory thresholds (VT) enables areliable determination of the individual cardiopulmonary performance (peakVO2) and also the aerobic exercise capacity. In addition, CPX is avaluable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO2 and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type2 diabetes mellitus.

Long-Term Results of Serial Exercise Testing and Echocardiography Examinations in Patients with Pulmonary Stenosis.

Pulmonary stenosis (PS) affects cardiopulmonary function and exercise performance. Cardiopulmonary exercise testing (CPET) together with transthoracic echocardiography (TTE) can measure exercise performance, PS progression, and treatment effects. We assessed exercise capacity in PS patients using these methods. We enrolled 28 PS patients aged 6-35 years who received surgery, balloon pulmonary valvuloplasty, and follow-up care. The control population was selected by a 1:1 matching on age, sex, and body mass index. Baseline and follow-up peak pulmonary artery pulse wave velocity (PAV) were compared using TTE. Initial CPET revealed no significant differences in anaerobic metabolic equivalent (MET), peak oxygen consumption (VO2), and heart rate recovery between the two groups, nor were significant differences in pulmonary function identified. Within the PS group, there were no significant differences in MET, peak VO2, and heart rate recovery between the baseline and final CPET. Similarly, no significant differences were observed between the baseline and final PAV. The exercise capacity of patients with properly managed PS was comparable to that of healthy individuals. However, during the follow-up, declining trends in pulmonary function, aerobic metabolism, and peak exercise load capacity were observed among adolescents with PS. This study provides long-term data suggesting that PS patients should be encouraged to perform physical activity. Regular reevaluation should also be encouraged to limit performance deterioration.

Rehabilitation in fibrodysplasia ossificans progressive - experience Report

Introduction: Fibrodysplasia Ossificans Progressiva causes gradual limitation of joint range of motion by heterotopic osteogenesis in various connective tissue structures. It is a rare autosomal dominant disease and is correlated with the presence of congenital malformation of the bilateral hallux valgus, presence of ossification that appears spontaneously or precipitated by trauma. Method: The search for the respective titles for FOP and Rehabilitation via a bibliographic review in the Pubmed database, the titles and abstracts were discriminated when they did not bring in their content the treatment of this disease. Results and Discussion: The 9-year-old patient comes with complaints of pain in the joints of the shoulders, elbows, cervical and thoracic spine. Slow walking, structural deformities in the axial axis of the cervico-thoracic spine, decreased shoulder abduction up to 15°, limited elbow flexion and extension. The FOP treatment strategy is a comprehensive program of activities to prevent the myriad possibilities of trauma, from avoiding unnecessary surgical procedures, injections and even biopsies. Dry needling or acupuncture techniques are always contraindicated. Hydrotherapy turns out to be another useful tool in the process of preventing and relieving injuries, contributing to physical conditioning in a safe environment with low impact and cardiopulmonary performance. From the clinical observations, there will be indication of orthoses, auxiliary means for locomotion or adapted wheelchairs. Devices with voice command facilitate some daily activities, encouraging music therapy, dance or theater also favors the well-being of these patients. Conclusion: The disease has some striking characteristics that favor early diagnosis. Injury prevention, medical management of acute painful flare-ups, and rehabilitation are pillars of treatment. There is still no curative treatment, however, the determination of a therapeutic plan prevents future trauma and can guarantee an adequate prognosis even though it is difficult and full of functional limitations for patients.

Public perception and willingness towards bystander cardiopulmonary resuscitation (CPR) training and performance in Pakistan

Background/Aim: Bystander cardiopulmonary resuscitation (CPR) during out of-hospital cardiac arrest increases both survival rates and neurological recovery, but in Pakistan, an alarmingly low 2.3 % of these individuals receive bystander CPR. This study was designed to identify the reasons that affect the perception and willingness of the public toward bystander CPR training and performance in Lahore, Pakistan. Methods: A CPR master trainer from the USA visited various organisations from 1 December 2022 to 31 January 2023, to conduct training sessions. Before and after the training, a questionnaire was distributed among respondents to fill in. The subjects were asked to answer questions about their perception and willingness to perform bystander CPR. Results: Out of 401 participants, 240 completed the survey, with a response rate of 59.85 %. The majority of them were males [146 (60.8 %)], 215 (89.6 %) were below the age of 40, 107 (44.6 %) were graduated, 182 (75.8 %) never participated in any CPR training, mainly due to their ignorance towards the importance of bystander CPR (52.8 %) and 152 (63.3 %) were eager to participate in the CPR training course. Furthermore, the leading problem in providing bystander CPR was lack of technique or fear of possible harm that can be proved fatal (48.8 %), followed by concerns related to involvement in any legal procedure (10.0 %). Conclusions: Bystander CPR is still uncommon in Pakistan. Participants were reluctant to perform bystander CPR because of various concerns and fears. Lack of proper skill and causing additional harm were the main reasons associated with this. Hence, while improving CPR training and public education, these findings must be considered.

The relationship between computed tomography‐derived sarcopenia, cardiopulmonary exercise testing performance, systemic inflammation, and survival in good performance status patients with oesophago‐gastric cancer undergoing neoadjuvant treatment

AbstractBackgroundThought to capture the nutritional and functional reserve of the cancer patient, whether the computed tomography (CT)‐derived sarcopenia score (CT‐SS) has complimentary prognostic value to commonly utilized pre‐treatment host assessments in patients with oesophago‐gastric (OG) cancer is unknown. The aim of the present study was to examine if the CT‐SS can stratify survival in OG cancer patients with good performance status [Eastern Cooperative Oncology Group Performance Status (ECOG‐PS) 0/1]. Furthermore, if the CT‐SS had complimentary prognostic value to cardiopulmonary exercise testing (CPET) performance and systemic inflammation.MethodsConsecutive patients with confirmed OG cancer and good performance status, who received neoadjuvant chemotherapy (NAC) with a view to surgical resection with curative intent, between 1 January 2010 and 31 December 2015, within NHS Greater Glasgow and Clyde (NHSGGC) and NHS Forth Valley (NHSFV), were identified from a prospectively maintained database. CT‐SSs were grouped as 0/1/2. CPET variables recorded included VO2 anaerobic threshold (AT) and peak. Systemic inflammatory response was determined by modified Glasgow prognostic score (mGPS) and neutrophil/lymphocyte ratio (NLR). Associations between categorical variables were examined using χ2 test and binary logistics regression analysis.ResultsA total of 232 patients met the inclusion criteria. 75% (n = 174) of patients were male, 54% (n = 126) were 65 years or older, and 60% (n = 139) were overweight [body mass index (BMI) ≥25 kg/m2]; 33% (n = 77) of patients had CT‐SS ≥ 1, 36% (n = 83) had a low VO2 AT (≤11 ml/kg/min), and 57% (n = 132) had a low VO2 peak (≤19 ml/kg/min). Of the 200 patients who had pre‐NAC bloods facilitating calculation of the mGPS, 28% (n = 55) had mGPS ≥ 1. Of the 211 patients who had pre‐NAC bloods facilitating calculation of NLR, 38% (n = 80) had an NLR ≥ 3; 82% (n = 190) and 53% (n = 122) were alive at 1 and 3 years post‐NAC, respectively. On univariate analysis, CT‐SS was significantly associated with sex (P < 0.05), histological cell type (P < 0.05), low VO2 AT (P < 0.05), low VO2 peak (P < 0.05), BMI (P < 0.05), mGPS (P < 0.05), and 3‐year survival (P < 0.05). On multivariate analysis, tumour, node, and metastasis (TNM) stage (P < 0.05) and CT‐SS (P < 0.05) remained significantly associated with 3‐year survival. CT‐SS was significantly associated with 3‐year survival in patients who had mGPS 0 (P < 0.05), but not low VO2 AT (P = 0.066) or peak (P = 0.065).ConclusionThe CT‐SS would appear to capture the nutritional and functional reserve of the patient and is a useful objective measure for stratifying long‐term survival in patients with good performance status undergoing potentially curative treatment for OG cancer.

Recovery of performance and persistent symptoms in athletes after COVID-19.

After the acute Sars-CoV-2-infection, some athletes suffer from persistent, performance-impairing symptoms, although the course of the disease is often mild to moderate. The relation between cardiopulmonary performance and persistent symptoms after the acute period is still unclear. In addition, information about the development of this relationship is lacking. To assess the prevalence of persistent symptoms over time and their association with the performance capability of athletes. We conducted two cardiopulmonary exercise tests (CPET) in a three months interval with 60 athletes (age: 35.2±12.1 years, 56.7% male) after infection with Sars-CoV-2 (t0: study inclusion; t1: three months post t0). At each examination, athletes were asked about their persistent symptoms. To evaluate the change of Peak VO2/BM (Body Mass) between the time before infection and the first examination, the VO2/BM (predVO2) before infection was predicted based on anthropometric data and exercise history of the athletes. For data analysis, athletes were grouped according to their symptom status (symptom-free, SF; persistent symptoms, PS) and its progression from the first to the second examination 1) SF-SF, 2) PS-SF and 3) PS-PS. Comparing the SF and PS groups at t0, significant differences for Max Power/BM, Max Power/lbm (lean body mass), Peak VO2, Peak VO2/BM, Peak VO2/lbm, Peak VO2/HR, Peak VE, Peak Vt and VE/VCO2-Slope were observed. Regarding the progression over three months, an increase in Max Power/BM was shown in SF-SF and PS-SF (tendency). Max Power/lbm increased in SF-SF and PS-PS (tendency). A decrease of VE/VCO2-Slope in PS-PS was found. COVID-19 led to a decline in performance that was greater in PS than in SF. Additionally, PS had decreased ventilatory parameters compared to SF. Furthermore, an improvement over time was observed in some CPET parameters and a partial recovery was observed judging by the decrease in various symptoms.

Repeated cardiopulmonary performance measurements in young competitive handball players with and without SARS-CoV-2 infection

BackgroundThe SARS-CoV-2 virus and its long-term consequences in adolescents have a global impact on upcoming medical issues. The aim of this study was to investigate the effects of a SARS-CoV-2 infection on cardiorespiratory parameters in young athletes.MethodsIn a cohort study involving repeated measurements during a six-month period, cardiorespiratory parameters were assessed in infected (SCoV) and non-infected (noSCoV) athletes. We evaluated handball players (17.2 ± 1.0 years) via performance diagnostics and a specific examination after a SARS-CoV-2 infection or without.ResultsWe observed no significant differences between the two groups at the first visit. But between the first and second visit, the SCoV group’s maximum power output was significantly lower than the noSCoV group’s (− 48.3 ± 12.5; p ≤ 0.01 vs. − 15.0 ± 26.0 W; p = 0.09). At the second visit, lung diffusion capacity (DLCO/VA, %predicted) did not differ between groups (111.6 ± 11.5 vs. 116.1 ± 11.8%; p = 0.45). HR during comparative stress showed no group differences. The SCoV group’s mean oxygen uptake during incremental exercise was lower (Two-way-ANOVA: 1912 vs. 2106 ml; p ≤ 0.01; mean difference: − 194 ml; 95% CI − 317 to − 71); we also noted a significantly lower stroke volume course during exercise (Two-way-ANAOVA: 147.5 vs. 169.5 ml; mean difference: − 22 ml; p ≤ 0.01; 95% CI − 34.2 to − 9.9). The probability of premature ventricular complexes after a SARS-CoV-2 infection yielded an odds ratio of 1.6 (95% CI 0.24–10.81).ConclusionsThe physical performance of young athletes infected with SARS-CoV-2 was impaired. This decreased performance is probably due to cardiac and/or peripheral deconditioning. Studies with larger cohorts are needed to make more profound conclusions.

Epicardial adipose tissue thickness is associated with reduced peak oxygen consumption and systolic reserve in patients with type 2 diabetes and normal heart function.

To investigate the impact of epicardial adipose tissue (EAT) thickness on cardiopulmonary performance in patients with type 2 diabetes (T2D) and normal heart function. We analysed EAT thickness in subjects with T2D and normal biventricular systo-diastolic functions undergoing a maximal cardiopulmonary exercise test combined with stress echocardiography, speckle tracking and pulmonary function assessment, as well as serum N-terminal pro B-type natriuretic peptide (NT-proBNP). In the 72 subjects enrolled, those with EAT thickness above the median (> 5 mm) showed higher body fat mass, smaller indexed left ventricular dimensions and marginally reduced diastolic function variables at rest. Higher EAT thickness was associated with lower peak oxygen uptake (VO2peak 17.1 ± 3.6 vs. 21.0 ± 5.7ml/min/kg, P=.001), reduced systolic reserve (ΔS' 4.6 ± 1.6 vs. 5.8 ± 2.5m/s, P=.02) and higher natriuretic peptides (NT-proBNP 64 [29-165] vs. 31 [26-139] pg/ml, P=.04), as well as chronotropic insufficiency and impaired heart rate recovery. Ventilatory variables and peripheral oxygen extraction were not different between groups. EAT was independently associated with VO2peak and linearly and negatively correlated with peak heart rate, heart rate recovery, workload, VO2 at the anaerobic threshold and at peak, and cardiac power output, and was directly correlated with natriuretic peptides. Higher EAT thickness in T2D is associated with worse cardiopulmonary performance and multiple traits of subclinical cardiac systolic dysfunction.

Application of the Team Emergency Assessment Measure for Prehospital Cardiopulmonary Resuscitation.

Introduction: Communication and teamwork are critical for ensuring patient safety, particularly during prehospital cardiopulmonary resuscitation (CPR). The Team Emergency Assessment Measure (TEAM) is a tool applicable to such situations. This study aimed to validate the TEAM efficiency as a suitable tool even in prehospital CPR. Methods: A multi-centric observational study was conducted using the data of all non-traumatic out-of-hospital cardiac arrest patients aged over 18 years who were treated using video communication-based medical direction in 2018. From the extracted data of 1494 eligible patients, 67 sample cases were randomly selected. Two experienced raters were assigned to each case. Each rater reviewed 13 or 14 videos and scored the TEAM items for each field cardiopulmonary resuscitation performance. The internal consistency, concurrent validity, and inter-rater reliability were measured. Results: The TEAM showed high reliability with a Cronbach’s alpha value of 0.939, with a mean interitem correlation of 0.584. The mean item–total correlation was 0.789, indicating significant associations. The mean correlation coefficient between each item and the global score range was 0.682, indicating good concurrent validity. The mean intra-class correlation coefficient was 0.804, indicating excellent agreement. Discussion: The TEAM can be a valid and reliable tool to evaluate the non-technical skills of a team of paramedics performing CPR.

Effects of surgical and FFP2 masks on cardiopulmonary exercise capacity in patients with heart failure.

Surgical and FFP2 masks are recommended to reduce transmission of SARS-CoV-2. The cardiopulmonary effects of facemasks in patients with chronic heart failure are unknown. This prospective, cross-over study quantified the effects of wearing no mask (nm), surgical mask (sm), and FFP2 mask (ffpm) in patients with stable heart failure. 12 patients with clinically stable chronic heart failure (HF) (age 63.8±12 years, left ventricular ejection fraction (LVEF) 43.8±11%, NTProBNP 573±567 pg/ml) underwent spiroergometry with and without masks in a randomized sequence. Comfort/discomfort was assessed using a standardized questionnaire. Maximum power was reduced with both types of masks (nm: 108.3 W vs. sm: 101.2 W vs. ffpm: 95.6 W, p<0.01). Maximum respiratory oxygen uptake (1499ml/min vs. 1481 ml/min vs. 1300 ml/min, p = 0.95 and <0.01), peak ventilation (62.1 l/min vs. 56.4 l/min vs. 50.3 l/min, p = 0.15 and p<0.05) and O2-pulse (11.6 ml/beat vs. 11.8 ml/beat vs. 10.6 ml/beat, p = 0.87 and p<0.01) were significantly changed with ffpm but not sm. Discomfort was moderately but significantly increased (nm: 1.6 vs. sm: 3.4 vs. ffpm: 4.4, p<0.05). Both surgical and FFP masks reduce exercise capacity in heart failure patients, while FFP2 masks reduce oxygen uptake and peak ventilation. This reduction in cardiopulmonary performance should be considered in heart failure patients whose daily life activities are often just as challenging as exercise is for healthy adults.

Implementation of a Pediatric Emergency Department Cardiopulmonary Resuscitation Quality Bundle.

We have previously demonstrated that standardized handoff from prehospital to hospital clinicians can improve cardiopulmonary resuscitation performance for out-of-hospital cardiac arrest (OHCA) patients in a pediatric emergency department (ED). We leveraged our previous quality improvement initiative to standardize performance of a bundle of 5 discrete aspects of resuscitation for OHCA patients: intravenous or intraosseous catheter (IV/IO) access, epinephrine administration, advanced airway placement, end-tidal capnography (ETCO2) application, and cardiac rhythm verbalization. We aimed to reduce time to completion of the bundle from 302 seconds at baseline to less than 120 seconds within 1 year. A multidisciplinary team performed video-based review of actual OHCA resuscitations in our pediatric ED. We designed interventions aimed at key drivers of bundle performance. Interventions included specific roles and responsibilities and a standardized choreography for each bundle element. To assess the effect of the interventions, time to performance of each bundle element was measured by standardized review of video recordings from our resuscitation bay. Balancing measures were time off the chest and time to defibrillator pad placement. We analyzed 56 cases of OHCA from May 2019 through May 2021. Time to bundle completion improved from a baseline of 302 seconds to 147 seconds. Four of 5 individual bundle elements also demonstrated significant improvement. These improvements were sustained without any negative impact on balancing measures. Standardized choreography for the initial minutes of ED cardiac arrest resuscitation shows promise to decrease time to crucial interventions in children presenting to the pediatric ED with OHCA.

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

BackgroundFindings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF.MethodsPatients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D.ResultsCompared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2).ConclusionThe higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis.Trial registration ClinicalTrials.gov identifier: NCT023358017

CARDIOPULMONARY TEST PARAMETERS USEFUL FOR ADDRESSING PATIENTS WITH PECTUS EXCAVATUM TO PROMOTION OF PHYSICAL ACTIVITY

Objective: Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake positively affecting cardiac output. In subjects with pectus excavatum cardiac output increase during exercise might be limited by the conformation of the chest. In this condition, the psychological impact of the deformity can further reduce the propensity to physical activity, leading to a sedentary lifestyle. Surgery is the preferred choice in severe cases. However, many patients with milder deformities can benefit from exercise-based treatment. The choice of the therapeutic strategy is fundamental, but the functional parameters on which to base this choice are not yet well defined. Therefore, we investigated the relationships between habitual physical activity and functional physiological parameters obtained from the cardiopulmonary exercise test (exercise performance and stroke volume at peak exercise) in pectus excavatum. Design and method: A cohort of adolescents (15 with pectus excavatum and 15 age- and sex-matched healthy controls) underwent Cardiopulmonary Exercise Test to estimate exercise performance (VO2 max) and stroke volume at peak exercise (VO2/HR, O2 pulse). Habitual weekly physical activity, estimated with International Physical Activity Questionnaire – Short Form (IPAQ-SF), was expressed as METs h-1·week-1. Determinants of exercise performance and stroke volume at peak exercise were investigated in the whole group with multivariable linear regression analysis adjusted for sex, body mass index, forced expiratory volume in the first second, and presence of pectus excavatum. Results: When compared to healthy controls, subjects with pectus excavatum had lower VO2 max (37.2 ± 6.6 vs 45.4 ± 6.4 mL·kg-1·min-1, p &lt; 0.05), and O2 pulse (12.1 ± 2.4 vs 16.2 ± 3.6 mL·min-1·bpm-1, p &lt; 0.05). Importantly, physical activity level was a predictor of VO2 max (B = 0.085; 95% Cl 0.010 to 0.160) while it did not affect O2 pulse (B = 0.035; 95% Cl -0.004 to 0.074). Conclusions: Training programs should be encouraged to increase cardiopulmonary performance in subjects with pectus excavatum. A marked reduction in O2 pulse at peak exercise might be considered as a criteria to address a subject towards surgery.

Cardiopulmonary Exercise Performance in the Pediatric and Young Adult Population Before and During the COVID-19 Pandemic.

Physical activity (PA) decreased and sedentary behavior (SB) increased in the pediatric population during the Coronavirus Disease 2019 (COVID-19) pandemic. We examined the effects of PA and SB on cardiopulmonary exercise performance in children, adolescents and young adults both with and without underling cardiac disease, and hypothesized that there will be a change in aerobic and physical working capacity during the pandemic. This was a single-center retrospective longitudinal cohort study in patients age 6–22 years who underwent serial maximal cardiopulmonary exercise stress testing before and during the COVID-19 pandemic. Metabolic variables were obtained; PA and SB data were extracted from clinic notes. A total of 122 patients (60% male) underwent serial exercise testing with a median age of 14 years at the first CPET. Predicted peak aerobic capacity significantly decreased among both females and males during the pandemic, even after adjusting for changes in somatic growth. There was no significant change in physical working capacity during the pandemic. Patients who were more aerobically fit experienced a greater decrease in aerobic capacity during the pandemic compared to those less fit. In conclusion, cardiopulmonary exercise performance, notably aerobic activity, decreased during the COVID-19 pandemic in children, adolescents and young adults compared to pre-pandemic values. This decline was most notable in those with the highest pre-pandemic aerobic capacity values and was independent of somatic growth or changes in BMI. This study has public health implications and demonstrates the importance of PA on overall cardiovascular health.