Cause Of Cardiorespiratory Arrest Research Articles

Cardiopulmonary arrest after cardiac surgery: A retrospective cohort of 142 patients with nine year follow up

BackgroundAlthough the techniques and perioperative management in modern cardiac surgeries has improved, and mortality and morbidity have decreased dramatically, postoperative cardiac arrest after heart surgery (POCHS) is a life-threatening condition that should be assessed and managed precisely. ObjectiveTo determine the mortality rate and causes of death in postoperative cardiac arrest after heart surgery (POCHS). MethodsA total of 3342 patients underwent cardiac surgery from 2010 to 2018 in Isfahan, Iran .142 of them experienced POCHS . POCHS patients were investigated for characteristics, causes of cardiopulmonary arrest, first-line treatment, and mortality. These items were compared between survived and deceased patients to find possible prognostic factors. ResultsThe incidence rate of cardiac arrest was 4.2% (142 ones from total of 3342). Success rate of cardiac arrest is 28.8% (41 from 142). Bradycardia was the most common cause of cardiorespiratory arrest (37.3%), followed by cardiogenic shock (30.3%) and ventricular fibrillation (23.2%). Younger patients (58±11.5 versus 62.9±11.3) and those who developed cardiopulmonary arrest due to ventricular fibrillation (42.4% versus 22.2%), bradycardia (21.2% versus 8.8%), and apnea (15.1% versus 6.6%) were more likely to survive, while, those with shock had the worst prognosis (P<0.05). The best response to resuscitation was found among those treated with defibrillator plus ECM (External Cardiac Massage) as compared to the other approaches (P-value=0.003). ConclusionBased on the current report, CPR success was found in 28.6% among whom respiratory etiology led to better outcomes than cardiac etiology. The second cause of cardiac arrest is ventricular fibrillation which immediate defibrillation has the best outcome. The highest numerical success in POCHS is combination of ECM with defibrillator.

Cervical spinal cord injury by a low-impact trauma as an unnoticed cause of cardiorespiratory arrest

BackgroundCardiorespiratory arrest (CA) secondary to traumatic cervical spinal cord injury can occur in minor accidents with low-impact trauma and may be overlooked as the cause of CA in patients admitted in the coronary care unit.Case summaryWe present two patients admitted to the coronary care unit because of suspected CA of cardiac origin. Both patients were found in CA with asystole, one after collapsing in a shopping mall and falling down a few steps and the other in the street next to his bicycle. They underwent early pharmacologically induced coma and hypothermia precluding neurological examination. Both patients remained in coma after rewarming, with preserved brainstem reflexes but absent motor response to pain. One patient had post-anoxic myoclonus in the face without limb involvement. In both patients, median nerve somatosensory evoked potentials demonstrated bilateral absence of thalamocortical N19 responses and abnormal cervicomedullary junction potentials (N13 wave). Extensive diagnostic work-up did not find a cardiac cause of the CA, pulmonary thromboembolism, or intracranial haemorrhage. In both patients, cervical spinal cord injury was diagnosed incidentally 5 and 6 days after CA, when a brain magnetic resonance imaging performed to assess post-anoxic brain injuries detected spinal cord hyperintensities with fracture and luxation of the odontoid. Both patients died 11 and 8 days after CA.DiscussionLow-impact traumatic cervical spinal cord injury should be considered in the diagnostic work-up of patients with CA of unknown cause.

A possible biomarker for methadone related deaths

Methadone (MTH) concentrations in those dying of MTH toxicity totally overlap concentrations where the presence of MTH is only an incidental finding, making it very difficult to make distinctions in actual cases. A biomarker, be it anatomical or biochemical for MTH toxicity is badly needed, particularly if that markers were known to disrupt effective ventilation. Because the brainstem houses the regulatory centers for cardiorespiratory-control enters, it would seem to be the most likely anatomical site to seek abnormalities in cardiorespiratory control. ObjectiveTo locate and describe the cells of nucleus of the solitary tract (TS)(NTS) in human brainstem and determine if neuronal cell death, either necrotic or apoptotic, within the TS of humans is more common in deaths due directly to MTH toxicity than with in the solitary tract itself. Design, setting, participantsThis was a single cohort study of MTH related decedents autopsied at a large university hospital. Each decedent had a recent history of non medical/illicit MTH use and had been pronounced dead in the field, prior to ever reaching the hospital. Complete autopsy and complete toxicology testing were performed on the formalin fixed brains of each individual. Multiple blocks were prepared of the area of interest, namely the tissue lying immediately between the inferior and the super colliculi. This volume, by definition, would have included the area of the Rostral Ventrolateral Medulla (RVLM), the location of the TS. Immunohistochemistry studies utilizing caspase-9 reaction (a protease enzyme involved in the process of preprogrammed death) were performed in order to estimate the degree and proportion of neuronal apoptosis, and also access the degree of classical necrosis within the NTS. Main outcomes and measuresThe primary outcome measure was the presence or absence of neuronal apoptosis and/or necrosis within the NTS. ResultsCells displaying evidence of early apoptosis and advanced apoptosis, consisting primarily of nuclear fragmentation, admixed with other neurons displaying the features of classic necrosis were found. Evidence of classic necrosis was identifiable in most of the controls, though minor degrees of apoptosis were identifiable with Caspase staining and quantitative image analysis of immunohistochemical stains. Conclusionsand Relevance: Our study shows that neurons, primarily along the TS, but occasionally in other cell nuclei (even controls) are vulnerable, both to direct MTH toxicity (via apoptosis) and indirectly (via hypoxia leading to classical cell necrosis). When MTH is found to be present in significant concentrations, but apoptotic lesions are absent, it would be reasonable to assume that MTH was not primarily the cause of cardiorespiratory arrest.

Extrahospitalary donors after cardiac dead

Introduction: The Madrid Emergency Medical Service (SUMMA112) in collaboration with Madrid's hospitals are employed at a program of donation of patients’ organs that have suffered out-of-hospital cardiac arrest and no response of advanced life support (ALS). These are Maastricht type II donors after cardiac dead. The objective is to describe the results of this program.Methods: Retrospective observational study based on review of emergency medical service database, case histories of donors after cardiac dead, and information provided by transplant units. The following variables were entered into the database: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonary arrest, time to arrival in hospital, number and type of organs retrieved, use of mechanical compression devices, and cause of no donation. The study period was January 2005 to April 2010.Results: 204 cases were transferred as potential donors. Average age 40 (10, 71). 85.5% was males. The cause of cardiorespiratory arrest was unknown 55.7%, cardiological 26.9%, neurological 2%, traumatic 5%, respiratory 3.5% and others 7%. The median time for EMS arrival from alert to the scene was 12′41″ and the interval from the alert to hospital was 83′45″. 149 cases (73%) were valid donors. The transplant organs were 228 kidneys, 35 liver, 108 eye tissue, 84 bone tissue and 16 lungs, a total of 471 organs. The average organs per valid donors were 3.16. 55 cases (27%) were no valid donors by extracorporeal bomb failure (7.2%), family negative (14.6%), judge negative (1.8%), biological reason (56.4%) and others (20%). The results in receipt patient of kidney were about 90% of normal function.Conclusions: The extrahospitalary donors after cardiac dead program has a successfully results with more than 3 organs per patient. The majority of these organs have a normal function in transplant. Introduction: The Madrid Emergency Medical Service (SUMMA112) in collaboration with Madrid's hospitals are employed at a program of donation of patients’ organs that have suffered out-of-hospital cardiac arrest and no response of advanced life support (ALS). These are Maastricht type II donors after cardiac dead. The objective is to describe the results of this program. Methods: Retrospective observational study based on review of emergency medical service database, case histories of donors after cardiac dead, and information provided by transplant units. The following variables were entered into the database: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonary arrest, time to arrival in hospital, number and type of organs retrieved, use of mechanical compression devices, and cause of no donation. The study period was January 2005 to April 2010. Results: 204 cases were transferred as potential donors. Average age 40 (10, 71). 85.5% was males. The cause of cardiorespiratory arrest was unknown 55.7%, cardiological 26.9%, neurological 2%, traumatic 5%, respiratory 3.5% and others 7%. The median time for EMS arrival from alert to the scene was 12′41″ and the interval from the alert to hospital was 83′45″. 149 cases (73%) were valid donors. The transplant organs were 228 kidneys, 35 liver, 108 eye tissue, 84 bone tissue and 16 lungs, a total of 471 organs. The average organs per valid donors were 3.16. 55 cases (27%) were no valid donors by extracorporeal bomb failure (7.2%), family negative (14.6%), judge negative (1.8%), biological reason (56.4%) and others (20%). The results in receipt patient of kidney were about 90% of normal function. Conclusions: The extrahospitalary donors after cardiac dead program has a successfully results with more than 3 organs per patient. The majority of these organs have a normal function in transplant.

Qualidade das anotações de enfermagem relacionadas à ressuscitação cardiopulmonar comparadas ao modelo Utstein

OBJETIVO: Analisar a qualidade das anotações de enfermagem relacionadas à ressuscitação cardiopulmonar, comparando-as ao protocolo validado Utstein, em um hospital universitário. MÉTODOS: Estudo retrospectivo, exploratório, descritivo, de abordagem quantitativa, realizado por meio de consulta a prontuários de pacientes que sofreram parada cardiorrespiratória (PCR) seguida de óbito. A coleta de dados foi realizada no período de 1° de maio a 30 de junho de 2009. RESULTADOS: Dos 144 prontuários consultados, 74 foram dispensados por não haver nenhuma informação registrada dos itens a serem estudados e, 70 constituíram a amostra do estudo. Nestes, não havia anotações referentes à causa imediata da PCR (92%), intervenções realizadas na tentativa de recuperação cardiorrespiratória (RCP) (71%), ritmo inicial de PCR (59%), hora dos eventos (16%), drogas utilizadas (50%) e profissionais envolvidos na RCP (88%). CONCLUSÕES: As anotações foram escassas e, frequentemente, não realizadas. A utilização do modelo Utstein favorece a anotação sequencial dos eventos, evitando a perda de dados.

Maintaining an airway

Patients who require resuscitation often have airway obstruction, usually secondary to loss of consciousness, however, sometimes airway obstruction may be the primary cause of cardiorespiratory arrest (Nolan et al 2005). Airway obstruction can be subtle and is often undetected. The nurse must be able to recognise and treat airway obstruction to help ensure adequate oxygenation.

Cervical Spine Injuries in Children

Cardiorespiratory arrest occurring immediately after multiple injuries is usually assumed to be due to severe cerebral injury, acute hemorrhage, or airway obstruction. We have identified a group of 19 children (mean age, 6.3 years) who presented with absent vital signs (VSA) or severe hypotension, unexplained by blood loss, where these findings were caused by injury to the high cervical spine and cord, demonstrated either by X-ray or postmortem examination. Fourteen had radiologic evidence of injury to the spine between C1 and C3. In two patients the bony injury was at the C6-7 level, while in two patients the cervical spine X-ray was normal. Eighteen of the 19 children were initially resuscitated but died from a combination of hypoxic/ischemic encephalopathy and cerebral injury. Sixteen patients underwent postmortem examination and in 13 there was evidence of cord laceration, up to and including cord transection. These findings demonstrate a distinct pattern of “juvenile” cervical spine injury involving the high spine and cord which results in either apnea and cardiorespiratory arrest, or severe hypotension. This previously unrecognized cause of cardiorespiratory arrest should be considered in all children presenting with VSA after multiple trauma, even when there is no apparent radiologic abnormality of the cervical spine.

Cervical Spine Injuries in Children

Cardiorespiratory arrest occurring immediately after multiple injuries is usually assumed to be due to severe cerebral injury, acute hemorrhage, or airway obstruction. We have identified a group of 19 children (mean age, 6.3 years) who presented with absent vital signs (VSA) or severe hypotension, unexplained by blood loss, where these findings were caused by injury to the high cervical spine and cord, demonstrated either by X-ray or postmortem examination. Fourteen had radiologic evidence of injury to the spine between C1 and C3. In two patients the bony injury was at the C6-7 level, while in two patients the cervical spine X-ray was normal. Eighteen of the 19 children were initially resuscitated but died from a combination of hypoxic/ischemic encephalopathy and cerebral injury. Sixteen patients underwent postmortem examination and in 13 there was evidence of cord laceration, up to and including cord transection. These findings demonstrate a distinct pattern of "juvenile" cervical spine injury involving the high spine and cord which results in either apnea and cardiorespiratory arrest, or severe hypotension. This previously unrecognized cause of cardiorespiratory arrest should be considered in all children presenting with VSA after multiple trauma, even when there is no apparent radiologic abnormality of the cervical spine.