Cause Of Sudden Cardiac Arrest Research Articles

The Dutch Idiopathic Ventricular Fibrillation Registry: progress report on the quest to identify the unidentifiable.

Idiopathic ventricular fibrillation (iVF) is arare cause of sudden cardiac arrest and, by definition, adiagnosis of exclusion. Due to the rarity of the disease, previous and current studies are limited by their retrospective design and small patient numbers. Even though the incidence of iVF has declined owing to the identification of new disease entities, an important subgroup of patients remains. To expand the existing Dutch iVF Registry into alarge nationwide cohort of patients initially diagnosed with iVF, to reveal the underlying cause of iVF in these patients, and to improve arrhythmia management. The Dutch iVF Registry includes sudden cardiac arrest survivors with an initial diagnosis of iVF. Clinical data and outcomes are collected. Outcomes include subsequent detection of adiagnosis other than 'idiopathic', arrhythmia recurrence and death. Non-invasive electrocardiographic imaging is used to investigate electropathological substrates and triggers of VF. To date, 432 patients have been included in the registry (median age at event 40years (interquartile range 28-52)), 61% male. During amedian follow-up of 6(2-12) years, 38patients (9%) received adiagnosis other than 'idiopathic'. Eleven iVF patients were characterised with electrocardiographic imaging. The Dutch iVF Registry is currently the largest of its kind worldwide. In this heterogeneous population of index patients, we aim to identify common functional denominators associated with iVF. With the implementation of non-invasive electrocardiographic imaging and other diagnostic modalities (e.g. echocardiographic deformation, cardiac magnetic resonance), we advance the possibilities to reveal pro-fibrillatory substrates.

Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry

BackgroundCurrent cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. ObjectiveThe purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. MethodsThe study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. ResultsIn total, 42 patients received an underlying diagnosis during follow-up (median 7 [2–12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P = .16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16–18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P = .03). Inappropriate ICD therapy (26% vs 17%; P = .19), ICD complications (19% vs 14%; P = .41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. ConclusionIVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.

Slow flow in ectatic dilated coronary arteries as the cause of sudden cardiac arrest during diagnostic coronary angiography.

Slow flow in ectatic dilated coronary arteries as the cause of sudden cardiac arrest during diagnostic coronary angiography.

The New South Wales Sudden Cardiac Arrest Registry: A Data Linkage Cohort Study.

Sudden cardiac arrest (SCA) in young people aged 1 to 50 years often occurs with no presenting symptoms or risk factors prompting screening for cardiovascular disease prior to their cardiac arrest. Approximately 3,000 young Australians suffer from sudden cardiac death (SCD) each year, making this a major public health issue. However, there is significant variation in the way incidence is estimated resulting in discrepancy across reporting which impacts our ability to understand and prevent these devastating events. We describe the New South Wales (NSW) Sudden Cardiac Arrest Registry: a retrospective, data linkage study which will identify all SCAs in the young in NSW from 2009 through to June2022. To determine the incidence, demographic characteristics and causes of SCA in young people. We will develop an NSW-based registry that will contribute to a greater understanding of SCA including risk factors and outcomes. The cohort will include all people who experience a SCA in the NSW community aged between 1 to 50 years. Cases will be identified using the following three datasets: the Out of Hospital Cardiac Arrest Register housed at NSW Ambulance, the NSW Emergency Department Data Collection, and the National Coronial Information System. Data from eight datasets will be collected, anonymised and linked for the entire cohort. Analysis will be undertaken and reported using descriptive statistics. The NSW SCA registry will be an important resource for the improved understanding of SCA and inform the widespread impacts it has on individuals, their families and society.

Association of B-Type Natriuretic Peptide Level with Clinical Outcome in Out-of-Hospital Cardiac Arrest in Emergency Department Patients.

B-type natriuretic peptide (BNP) is used for outcome assessment of various diseases. We designed this study to investigate whether BNP, which has been proven useful in the risk stratification of sudden cardiac arrest (SCA) of cardiac etiology, can also prove to be a valuable prognostic tool for SCA also included with non-cardiac etiology. In this study, we aim to investigate the relationship between measured BNP levels and clinical outcomes in SCA, regardless of the cause of SCA. This retrospective multicenter observational study was performed in two tertiary university hospitals and one general hospital between January 2015 and December 2020. The total number of SCA patients was 1625. The patients with out-of-hospital cardiac arrest over 19 years old and acquired laboratory data, including BNP at emergency department (ED) arrival, were included. BNP was measured during advanced Cardiovascular Life Support (ACLS). The exclusion criteria were age under 18 years, traumatic arrest, and without BNP. The median BNP was 171.8 (range; 5-5000) pg/mL in the return of Spontaneous Circulation (ROSC), higher than No-ROSC (p = 0.007). The median BNP concentration was 99.7 (range; 5-3040.68) pg/mL in the survival to discharge, which was significantly lower than the death group (p = 0.012). The odds ratio of survival to discharge decreased proportionally to the BNP level. The odds ratio of neurologic outcome was not correlated with the BNP level. In patients with SCA of all origins, low BNP concentration measured during ACLS correlated with an increased ratio of survival to discharge. However, BNP measured during ACLS was not found to be an independent factor.

Ethics of data-driven innovation in the treatment and prevention of sudden cardiac arrest

Ethics of data-driven innovation in the treatment and prevention of sudden cardiac arrest ESCAPE-NET aims to discover inherited, acquired and environmental causes of sudden cardiac arrest (SCA) and to improve resuscitation treatment for SCA. A shared database of more than 100,000 SCA patients has been created and less than 10,000 DNA samples collected, with procedures for data access by researchers outside the project consortium. ESCAPE-NET has generated 90 peer-reviewed scientific papers.

The role of genetic testing in the prevention, diagnosis, and prognosis of sudden cardiac arrest in children.

Determining the pathogenesis of sudden cardiac arrest (SCA) in children is crucial for its management and prognosis. Our aim is to analyze the role of broad genetic testing in the prevention, diagnosis, and prognosis of SCA in Children. ECG, 12-lead holter, exercise testing, cardiac imaging, familial study, and genetic testing were used to study 29 families, in whom a child experienced SCA. After a thorough clinical and genetic evaluation a positive diagnosis was reached in 24/29 (83%) families. Inherited channelopathies (long QT syndrome and catecholaminergic polymorphic ventricular tachycardia) were the most prevalent 20/29 (69%) diagnosis, followed by cardiomyopathy 3/29 (10%). Broad genetic testing was positive in 17/24 (71%) cases. Using the Mann-Whitney test, we found that genetic testing (effect size = 0.625, p = 0.003), ECG (effect size = 0.61, p = 0.009), and exercise test (effect size = 0.63, p = 0.047) had the highest yield in reaching the final diagnosis. Genetic testing was the only positive test available for five (17%) families. Among 155 family members evaluated through cascade screening, 73 (47%) had a positive clinical evaluation and 64 (41%) carried a pathologic mutation. During 6 ± 4.8 years of follow-up, 58% of the survived children experienced an arrhythmic event. Of nine family members who had an ICD implant for primary prevention, four experienced appropriate ICD shock. The major causes of SCA among children are genetic etiology, and genetic testing has a high yield. Family screening has an additional role in both the diagnosis and preventing of SCA.

PO-01-076 DIAGNOSIS OF CORONARY VASOSPASM PROMPTED BY EPISODIC ST ELEVATION ON A CONSUMER MOBILE ECG DEVICE

Mobile ECG-enabled devices are increasingly used by consumers with limited data on sensitivity to detect ischemic ECG changes. Coronary vasospasm is an important cause of sudden cardiac arrest. The aim of this report is to present a case of a man who was determined to have coronary vasospasm resulting in ST elevation and VF. The patient came to medical attention after recording apparent ST elevation on a consumer mobile ECG device. N/A The patient is a 64-year-old man with paroxysmal atrial fibrillation previously treated with catheter ablation with an implantable loop recorder in place. Two weeks prior to his presentation to our institution, he collapsed at church. He was found to be pulseless and underwent bystander CPR. In-field ECG revealed ventricular fibrillation requiring defibrillation (Figure 1A). Subsequent ECG revealed inferior ST elevation. Coronary angiography demonstrated significant stenosis in the left circumflex artery and mild disease in the right coronary artery. Percutaneous coronary intervention of the left circumflex artery was performed with drug eluting stent. The patient was prescribed aspirin, clopidogrel, and metoprolol. Implantable cardioverter defibrillator placement was deferred as his cardiac arrest was felt to be due to an acute coronary syndrome treated with revascularization. Over the subsequent two weeks, the patient reported episodic sensations of chest uneasiness. He recorded a 6 lead ECG on his AliveCor Kardia device at baseline (Figure 1B) and during symptoms (Figure 1C). Exercise treadmill stress testing revealed no evidence of ischemia. Due to ongoing symptoms, he presented to our institution. Baseline ECG was normal. On telemetry, dynamic ST changes were noted with morphology matching the tracing recorded on his Kardia device, followed by degeneration into nonsustained VF (Figure 1D-F). Coronary angiography revealed a patent left circumflex artery stent and stable non-obstructive right coronary artery disease. Echocardiography was normal. Cardiac biomarkers were normal. A diagnosis of coronary vasospasm was made. The patient was managed with amlodipine and isosorbide mononitrate. After an informed discussion, the patient was discharged with a wearable cardioverter defibrillator. He has not had any arrhythmias or ischemic symptoms during follow-up. While typically used to diagnose arrhythmias, mobile ECG monitors may record ischemic electrocardiographic changes. These may assist in the diagnosis of coronary vasospasm.

PO-05-126 A SHOCKING TURN OF EVENTS: PRIMARY CARDIAC LYMPHOMA AS A RARE CAUSE FOR SUDDEN CARDIAC DEATH

Primary cardiac tumors are rare causes of ventricular arrythmias. This presentation of primary cardiac lymphoma highlights the importance of multimodality cardiac imaging for patients who suffer sudden cardiac arrest. N/A N/A A previously healthy 34 year-old woman suffered an out-of-hospital cardiac arrest. She received bystander CPR and multiple shocks in the field for VT and VF. ECG obtained on arrival showed salvos of monomorphic VT with a LBBB morphology as well as polymorphic VT. Post-arrest ECG demonstrated dynamic changes with evidence of a prolonged QT interval and Brugada type 1 pattern. After stabilization with metoprolol and intravenous lidocaine, cardiac MRI showed an infiltrating mass along the epicardial surface of the right ventricular outflow tract (RVOT). A cardiac CT was subsequently performed for surgical biopsy planning. Biopsy was obtained via hemi-sternotomy; tissue histopathology of the RVOT mass revealed diffuse large B-cell lymphoma. PET and CT scans indicated no evidence of metastatic disease. The patient was diagnosed with primary cardiac lymphoma, and underwent inpatient chemotherapy treatment. A subcutaneous ICD was implanted prior to discharge for secondary prevention. Key images are displayed in Figure 1. This case demonstrates a rare cause of sudden cardiac arrest in a young patient with a new diagnosis of primary cardiac lymphoma. Primary cardiac lymphoma is a very rare disease that accounts for less than 1% of all primary cardiac malignancies, and less than 0.5% of all extra nodal lymphomas. The use of multimodality imaging after a cardiac arrest in this case led to a timely diagnosis and rapid initiation of life saving treatments.

Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence, predictors, and related outcomes.

ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI. This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11  years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed. During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, p < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group. In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.

Intramural course of an anomalous left coronary artery is not always associated with a slit-like ostium.

Anomalous aortic origin of the left coronary artery from an incorrect aortic sinus has been reported as the second most common causes of sudden cardiac arrest in young athletes. Intramural course of the proximal left coronary artery is considered a high-risk morphology. It is associated with a slit-like ostium and elliptical shape of the proximal artery. In this case, all pre-operative cardiac images demonstrated a round ostium and round luminal shape of the left coronary artery, which suggested no evidence of intramural course. On intraoperative inspection, although the ostium and proximal left coronary artery appeared round, the patient had a long intramural course of the left coronary artery which our surgeons performed a successful unroofing procedure. The post-operative images showed a patent new ostium from the correct aortic sinus. These findings are very unusual and proved that we should not exclude intramural course even in the absence of a slit-like ostium and elliptical shape of the proximal left coronary artery.

Two case reports of sudden cardiac arrest with unsuccessful resuscitation: is there a role for postmortem investigation and targeted next generation sequencing?

Background: Sudden unexpected cardiac arrest is one of the life-threatening interventions of the pre hospital emergency medicine teams. Globally sudden cardiac death (SCD) accounts for 4-5 million deaths per year and is in most cases linked to coronary artery disease. Other causes include cardiomyopathies and channelopathies, but these are not always clear to the physician. Case Presentation: We present two unconscious patients with life-threatening cardiac arrests who were unsuccessfully resuscitated by the emergency team. As the cause of the sudden cardiac arrest was unclear an autopsy was performed. Conclusion: SCD can be the final stage of several pathologies. In acute myocardial infarction due to coronary artery disease, the underlying cause is clear. The situation is however more complex in drug abuse where the physician should be aware that underlying pathologies can be masked. If the cause of sudden cardiac arrest is unclear, a &amp;quot;molecular&amp;quot; autopsy is recommended to detect genetic susceptibility to dysrhythmias( long QT syndrome, Brugada syndrome), cardiomyopathies, thoracic aortic aneurysm, and dissection. Correlating significant clinical information, postmortem findings and genetic analysis can be used to detect underlying pathologies and to decide whether genetic screening and clinical follow up of relatives should be carried out.

DETERMINANTS OF EFFECTIVE CARDIOPULMONARY RESUSCITATION PERFORMED BY MEDICAL PERSONNEL

Aim: The aim of this paper is an attempt to analyse the determinants of effective cardiopulmonary resuscitation (CPR) performed by medical personnel over a five-year span. Material and methods: An original research questionnaire was used to collect and process data for the purposes of this retrospective observational study. The research sample consisted of 167 patients aged between 16 and 102 who had in-hospital sudden cardiac arrest (SCA) and underwent cardiopulmonary resuscitation (CPR). Results: The most common causes of SCA in the study group of patients were cardiovascular diseases, and the mechanism of asystole was responsible for half of the recorded sudden cardiac arrests. While performing CPR, chest compressions were the most frequently applied procedure, whereas defibrillation or the Esmarch (jaw-thrust) maneuver were used less often. The effectiveness of resuscitation in almost a half of the cases was unsatisfactory, whereas the average time of performing resuscitation was 27,83 minutes. Pronouncement of death was made with regard to patients on whom resuscitation was performed for the longest time. On the other hand, among patients who were resuscitated for less than 20 minutes, breathing, blood circulation and con¬sciousness were restored, or only breathing and circulation were restored. Conclusions: The main cause of sudden cardiac arrest in the study period were non-shockable heart rhythms, whereas the restoration of spontaneous cir¬culation and breathing was achieved in the cases when resuscitation was performed for less than 20 minutes. The survival rate after successful resuscitation is comparable to the results obtained in other hospitals in Poland and Europe, as well as statistical data from scientific publications.

Abstract 13870: Ventricular Fibrillation Arrest in a 27-Year-Old Woman Due to Takotsubo Cardiomyopathy

Introduction: Sudden cardiac death in young patients may be due to coronary artery disease, primary electrical disease, cardiomyopathy, or congenital anomalies. We explore potential causes for sudden cardiac arrest in a young patient. Case Description: A 27-year-old woman was found unconscious. Initial rhythm showed ventricular fibrillation. Cardiopulmonary resuscitation was done for 5 minutes before return of spontaneous circulation. ECG showed ST elevations in aVL, V4, and V5. She was admitted for therapeutic temperature management. Troponin peaked at 1.86 ng/mL on the evening of arrival. Transthoracic echocardiography (TTE) demonstrated hypokinesis of the mid to distal septum, anterior wall, and apex (Figure 1). Repeat TTE 3 days later showed resolution of the wall motion abnormalities. She reported marijuana use and a domestic dispute with her significant other the night prior. Coronary CT angiography showed calcium score of 0 with normal coronary anatomy, no significant coronary artery stenosis, and incidental finding of bilateral pulmonary artery filling defects. Lower limb venous duplex was unremarkable. Therapeutic dose of enoxaparin was started. Cardiac MRI showed no myocardial infarction, scar, or infiltrative disease. An electrophysiology study revealed adequate QT shortening during epinephrine infusion and no inducible ventricular arrhythmias. Genetic testing was unremarkable. She was discharged with a wearable defibrillator before ultimately receiving a subcutaneous implantable cardioverter-defibrillator. Discussion: The presentation of transient regional wall motion abnormalities, with ST-segment elevations and negative ischemic workup, is highly suggestive of Takotsubo cardiomyopathy, mid-ventricular variant. Marijuana use is a risk factor, and the domestic dispute is a potential emotional trigger. This case highlights Takotsubo cardiomyopathy as a possible cause of sudden cardiac arrest in young patients.

State-of-the-Art Multimodality Imaging in Sudden Cardiac Arrest with Focus on Idiopathic Ventricular Fibrillation: A Review.

Idiopathic ventricular fibrillation is a rare cause of sudden cardiac arrest and a diagnosis by exclusion. Unraveling the mechanism of ventricular fibrillation is important for targeted management, and potentially for initiating family screening. Sudden cardiac arrest survivors undergo extensive clinical testing, with a growing role for multimodality imaging, before diagnosing “idiopathic” ventricular fibrillation. Multimodality imaging, considered as using multiple imaging modalities as diagnostics, is important for revealing structural myocardial abnormalities in patients with cardiac arrest. This review focuses on combining imaging modalities (echocardiography, cardiac magnetic resonance and computed tomography) and the electrocardiographic characterization of sudden cardiac arrest survivors and discusses the surplus value of multimodality imaging in the diagnostic routing of these patients. We focus on novel insights obtained through electrostructural and/or electromechanical imaging in apparently idiopathic ventricular fibrillation patients, with special attention to non-invasive electrocardiographic imaging.

Characteristics and factors associated to patients discharging from hospital without an implantable cardioverter defibrillator after out-of-hospital cardiac arrest.

Guidelines recommend that in the absence of reversible cause for sudden cardiac arrest (SCA), implantable cardioverter defibrillator (ICD) should be performed to prevent further fatal event. We sought to describe the frequency and characteristics of patients discharged from the hospital without ICD after the SCA in the daily practice. From 2011 to 2018, all SCAs related to a cardiac cause admitted alive across the 48 hospitals of Great Paris Area were prospectively enrolled. Two investigators thoroughly reviewed each medical report to ensure accuracy of the assigned diagnosis towards identifying the cause of SCA and ICD implantation. Out of the 4314 SCA admitted alive at hospital admission, 1064 cardiac-related SCA survivors were discharged alive from hospital, including 356 patients (33.5%) with an ICD and 708 (66.5%) without. The principal underlying cause of SCA among those discharged without an ICD was acute coronary syndrome (ACS; 602, 85%), chronic coronary artery disease (41, 5.8%), structural non-ischaemic heart disease (48, 6.8%), and non-structural heart disease (17, 2.4%). Among ACS-related SCA, 93.8% (602/642) discharged without an ICD. The unique factor associated with non-ICD implantation in the setting of ACS was immediate coronary angioplasty (odds ratio 4.22, 95% confidence interval 1.86-9.30, P < 0.001). Two-thirds of SCA survivors were discharged without an ICD, mainly in the setting of ACS. The unique factor associated with non-ICD implantation among ACS was immediate coronary angioplasty emphasizing the fact that ACS definition must be precise since associated with ICD implantation or not.

A very rare cause of sudden cardiac arrest in children: triadin knockout syndrome.

A 7.5-year-old male patient was referred to our clinic with a history of recurrent syncope and aborted cardiac arrest. There was no family history of sudden death, syncope, or arrhythmia. Physical examination, electrocardiography, echocardiography, and 24-hour rhythm Holter monitoring were normal, and bidirectional ventricular tachycardiaT was detected during the exercise stress test. Genetic analysis revealed a homozygous mutation of c.531_533delinsGG, p.(Lys179Asnfs * 44) frameshift variant in TRDN(NM_006073) gene. A 4.5-year-old male was admitted due to syncope during exertion and underwent cardiopulmonary resuscitation due to sudden cardiac arrest. He had family history about sudden cardiac death. Physical examination was normal, and there was borderline QTc prolongation. Bidirectional non-sustained polymorphic ventricular tachycardia was observed at adrenaline provocation test. In genetic analysis, c.568dupA, pII190Asnfs * 2 frameshift variant homozygous mutation was detected in TRDN(NM_006073) gene. Intracardiac defibrillator implantation were performed for both cases. There has not been any event under propranolol and flecainide combination treatment. Triadin knockout syndrome (TCOS) is a rare overlap syndrome characterized by highly malignant arrhythmias, and it is a deadly combination of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia that affects primarily young children. Since lethal arrhythmias are frequently described, genetic testing is very important in these patients. Because, identification of a genetic mutation may be a guide in treatment.

The effect of hypothermia on the human body

IntroductionHypothermia may appear to be a benign condition, but it is an insidious and life-threatening dysfunction of the thermoregulatory system that occurs in all regions of the world, regardless of season. Hypothermia is caused by cooling when core body temperature decreases below 35°C. The information obtained during a patient interview is also helpful in establishing the causes of hypothermia. The pathophysiology of hypothermia has not been fully elucidated to date. It is rarely diagnosed, in particular in the temperate climate. Hypothermia poses a serious challenge for medical personnel, in particular medical rescue teams who arrive first at the scene.AimThe aim of this study was to present new information concerning hypothermia and the management of this condition.Material and methodsThis article reviews the available literature and statistical data relating to hypothermia, and it discusses various approaches to managing hypothermia, in particular in pre-hospital care.Results and discussionIn homeotherms, significant changes in body temperature affect the functioning of most organs and disrupt homeostasis. According to the European Resuscitation Council, hypothermia is one of the reversible causes of sudden cardiac arrest, which is why hypothermic patients should be adequately managed. Further research is also needed to expand our knowledge about hypothermia.ConclusionsHypothermia is an important cause of death particularly in the elderly, infants, and persons suffering from thermoregulatory disorders or diseases that influence thermogenesis. Therefore, education should be continued in this area and clinical studies should be conducted to deepen our understanding of this problem.

European sudden cardiac arrest network: towards prevention, education, and new effective treatments

European sudden cardiac arrest network: towards prevention, education, and new effective treatments ESCAPE NET aims to discover inherited, acquired and environmental causes of sudden cardiac arrest (SCA) and to improve resuscitation treatment for SCA. A shared database of less than 100,000 SCA patients has been created and more than 10,000 DNA samples collected, with procedures for data access by researchers outside the project consortium. ESCAPE-NET has generated 90 peer-reviewed scientific papers.

Congenital Cardiac Anesthesia: A Case-based Approach

The world of Pediatric Cardiology and Cardiac Surgery is filled with all manner of nonintuitive acronyms and eponyms: Ebstein’s Anomaly, Fontans of various sorts, Glenns, MBTS (Modified Blalock-Taussig Shunts), Mee shunts, Taussig-Bing hearts, Starnes Procedures, and many more. I have been practicing pediatric cardiac anesthesia for more than 30 yr and I still am left stumped occasionally when reading cardiology reports from outside institutions and have to resort to textbooks (or, more frequently now, Dr. Google) to figure out what cardiac condition or surgery my patient has had. Programs, cardiologists, and/or surgeons often use their own unique terminology. Multiple articles are readily found on PubMed addressing Pediatric Cardiac Disease and Procedural nomenclature and the need to use a common vernacular, but old habits persist. This idiosyncratic language serves as an effective barrier to the noncardiac practitioner and scares off many a pediatric anesthesiologist. However, it doesn’t seem to scare off their patients—more and more of whom present every day in the general operating rooms and labor and delivery suites for noncardiac procedures.There are now more survivors of pediatric cardiac surgery growing into childhood, adolescence, and adulthood than ever before. These patients frequently require a careful understanding of their physiology to safely anesthetize them for both minor and major procedures. Drs. Laura K. Berenstain and James P. Spaeth have edited a new book that helps navigate this challenging field in a case-based format that skillfully marries anatomy, physiology, and goal-directed care in a beautifully produced text. Each chapter opens with a brief clinical scenario summarizing the patient and planned procedure and their underlying cardiac diagnosis. The extremely well-written text is accompanied by the thoughtful use of diagrams, illustrations, and photographs to outline various anatomic and physiologic elements accompanying the cardiac defects. Care for the patient is not a cookbook—in fact, there is almost no mention of specific or suggested medications; rather, it is left to the practitioner to make those medical choices based on the patient’s pathology and physiology.I have been at this long enough to know that there is no “right” way to provide an anesthetic to these patients—many paths will lead to a safe landing as long as you understand the impact of your actions. There are no absolutes to be found in this text; the editors have chosen the 73 chapter authors from more than 20 institutions representing both large and small academic centers and high- and lower-volume practices. The authors represent the entire spectrum from fellows in pediatric cardiac anesthesia to internationally known professors of pediatric cardiac anesthesia, yet there is a consistency from chapter to chapter that speaks to the work put into the writing and editing of this text by Drs. Berenstain and Spaeth and their seven section editors.Congenital Cardiac Anesthesia: A Case-Based Approach is formatted around 50 chapters organized into 7 sections such as “Right-Sided Obstructive Lesions,” “Left-Sided Obstructive Lesions,” and “Complex Mixing Lesions,” each addressing a specific problem grouped by a common characteristic. Common lesions, such as tetralogy of Fallot for example, are presented across multiple chapters addressing both the unrepaired patient coming for cardiac surgery as well as the palliated or “repaired” patient undergoing a noncardiac procedure. The tetralogy with absent pulmonary valve (Tet-APV) receives its own chapter because of the implications to the bronchial tree from dilated pulmonary arteries while the tetralogy with pulmonary atresia and multiple aorto-pulmonary collaterals (Tet-MAPCAS) has a different set of physiologic challenges. Likewise, the Fontan (or total cavo-pulmonary connection) procedure, presented in Section 5 on “Single-Ventricle Physiology,” warrants three separate chapters: “Lateral Tunnel Fenestrated Fontan,” “Extracardiac Fontan,” and “Failing Fontan,” each of which has separate and distinct implications to the anesthesiologist caring for the patient. Each chapter in this 409-page text is concise, covering from 5 to 8 pages including illustrations, yet sufficiently detailed to quickly gain an understanding of the topic and its specific implications, and is accompanied by several important references. Within a given chapter are highlighted “Clinical Pearls” outlining the significant points of the preceding paragraphs. In Chapter 22 on “d-Transposition of the Great Arteries (Atrial Switch),” authored by Denise Joffe and Michael Eisses, for example, one finds “Clinical Pearl – An atrial switch procedure re-routes atrial blood via a baffle to the correct great vessel, albeit via the wrong ventricle. In contrast, in an arterial switch procedure the great vessels are transected and moved to the appropriate ventricle and the coronary arteries are reimplanted into the neoaortic root, thereby correcting the anatomy.” In two sentences the authors have summarized more than 50 yr of surgical decision-making and laid the groundwork for the management of the patient. One cardiac lesion not represented, that probably should have been included, is Anomalous Origin of the Coronary Arteries (ALCAPA, ARCAPA, and AAOCA). These lesions, although rare, are more common than pediatric lung transplantation, which was included, and are frequently the cause of sudden cardiac arrest in adolescent athletes or new onset heart failure in the neonatal period.This is not a comprehensive textbook of pediatric cardiac anesthesiology. You won’t find detailed listings of pharmacologic agents, dosing schema, and their cardiac effects or the embryologic underpinnings of AV canal defects. It is aimed instead at the much larger audience of the general pediatric or adult anesthesiologist who has 10 min to review for an upcoming case and needs a quick refresher on the anatomy, physiology, and implications of pediatric cardiac disease or for the adult cardiac anesthesiologist who is asked to care for a patient previously treated in a pediatric cardiac center now presenting emergently for a heart transplant or for adult congenital heart surgery. Given the ubiquitous nature of information today and the ready access to the internet in almost every operating location in the world, it is rare that I recommend a textbook to the trainees in pediatric anesthesia I work with daily. This text, however, is an exception and should be readily available for reference either electronically via the Amazon Kindle app or in hardcover.