Good Neurological Condition Research Articles

Effect of SARS-CoV-2 infection on out-of-hospital cardiac arrest outcomes - systematic review and meta-analysis.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has recently presented the world with an unprecedented challenge. The purpose of this systematic review and meta-analysis is to investigate the relationship between SARS-CoV-2 infection and out-of-hospital cardiac arrest (OHCA) by comparing data from infected and non-infected individuals. The study adds to our understanding of the broader effects of the pandemic on public health and emergency care by examining the influence of COVID-19 on OHCA. A comprehensive systematic literature search was performed using PubMed, EMBASE, Scopus, Web of Science, the Cochrane Library and Google Scholar from 1 January 2020 - 24 May 2023. Incidence rates and odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) for risk factors were recorded from individual studies, and random-effects inverse variance modelling used to generate pooled estimates. Six studies, involving 5,523 patients, met the criteria for inclusion in the meta-analysis. Survival to hospital admission, defined as admission to the emergency department with sustained return of spontaneous circulation (ROSC), among patients with and without on-going infection was 12.2% and 20.1%, respectively (p=0.09). Survival to hospital discharge/30-day survival rate was 0.8% vs. 6.2% (p<0.001). Two studies reported survival to hospital discharge in good neurological condition; however, the difference was not statistically significant (2.1% vs. 1.8%; p=0.37). Compared to the non-infected patients, the ongoing SARS-CoV-2 infection was associated with worse OHCA outcomes.

Iatrogenic Tracheal Rupture Related to Prehospital Emergency Intubation in Adults: A 15-Year Single Center Experience.

Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored. Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed. Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors. Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.

Chapter 13 - Intraoperative neurophysiology in intramedullary spinal cord tumor surgery

Intramedullary spinal cord tumor (ISCT) surgery is challenged by a significant risk of neurological injury. Indeed, while most ISCT patients arrive to surgery in good neurological condition due to early diagnosis, many experience some degree of postoperative sensorimotor deficit. Thus, intraoperative neuromonitoring (IONM) is invaluable for providing functional information that helps neurosurgeons tailor the surgical strategy to maximize resection while minimizing morbidity. Somatosensory evoked potential (SEP), muscle motor evoked potential (mMEP), and D-wave monitoring are routinely used to continuously assess the functional integrity of the long pathways within the spinal cord. More recently, mapping techniques have been introduced to identify the dorsal columns and the corticospinal tracts. Intraoperative SEP decline is not a sufficient reason to abandon surgery, since SEPs are very sensitive to anesthesia and surgical maneuvers. Yet, a severe proprioceptive deficit may adversely impact daily life, and the value of SEPs should be reconsidered. While mMEPs are good predictors of short-term motor outcome, the D-wave is the strongest predictor of long-term motor outcome, and its preservation during surgery is essential. Mapping techniques are promising but still need validation in large cohorts of patients to determine their impact on clinical outcome. The therapeutic rather than merely diagnostic value of IONM in spine surgery is still debated, but there is emerging evidence that IONM provides an essential adjunct in ISCT surgery.

A Case of Foramen Magnum and C1–C2 Meningiomas: Double Challenge, One Approach

Objectives We present a challenging case of a 61-year-old male patient with a double meningioma. The first one was located on the right side of foramen magnum and the second one was located on left anterolateral side of C1–C2. Background Patient referred at our institution for a progressive spastic paraparesis from approximately 1 year with a recent onset of numbness in right hand. Neuroradiological imaging showed an extra-axial enhancing tumor with a dural tail on the right border of foramen magnum and another contralateral extra-axial enhancing lesion at C1–C2 level ( Fig. 1 ). Results We have chosen a park bench position. Neurophysiological monitoring was used during both positioning and surgery. A linear skin incision in the occipital region extended to C7 was performed and a suboccipital craniotomy with the laminectomy of C1–C3 was performed ( Fig. 2 ). Videofluroangiography was performed to the best visualization of the vertebral artery position during microsurgical dissection and exposure of craniovertebral junction region. An Y -shape dural opening was executed and two meningiomas was resected with the classical four D steps (devascularize, detach, debulking, and dissect). All anatomical structures were respected and there were no changes at neuromonitoring. Patient was discharged after 10 days in good neurological condition. Conclusion a single approach for multiple meningiomas of the craniovertebral junction and upper cervical spine region is feasible and effective. Videofluoroangiography as a way to achieve better visualization and control of the vertebral artery, and neurophysiological monitoring are crucial tools to reduce the morbidity of this surgical challenge. The link to the video can be found at: https://youtu.be/4w9HCfQZkgg .

Prehospital Management of Peripartum Neonatal Complications by Helicopter Emergency Medical Service in the South West of the Netherlands: An Observational Study

ObjectiveEmergency medical service (EMS) is responsible for prehospital care encompassing all ages, irrespective of injury cause or medical condition, which includes peripartum emergencies. When patients require care more advanced than the level provided by the national EMS protocol, an EMS physician-staffed Dutch helicopter emergency medical service (HEMS) may be dispatched. In the Netherlands in 2016, there were 21.434 planned home births guided by midwives alone without further obstetric assistance, accounting for 12.7% of all births that year. However, there are no clear data available thus far regarding neonates requiring emergency care with or without HEMS assistance. This article reviews neonates during our study period who received medical care after birth by HEMS. MethodsA retrospective chart review was performed including neonates born on the day of the dispatch between January 2012 and December 2017 who received additional medical care from the Rotterdam HEMS. ResultsFifty-two neonates received medical care by HEMS. The majority (73.1%) were full-term (Gestational age > 37 weeks). Home delivery was intended in 63.5%, 20% of whom experienced an uncomplicated delivery but had a poor start of life. The majority of unplanned deliveries (n = 17) were preterm (70.6%). Two were born by resuscitative hysterotomy; 1 survived in good neurologic condition, and the other died at the scene. Fifteen neonates (28.9%) required cardiopulmonary resuscitation; in 2 cases, no resuscitation was started on medical grounds, and 12 of the other 13 resuscitated neonates regained return of spontaneous circulation. In 33 (63.5%) of the neonates, respiratory interventions were required; 8 (15.4%) were intubated before transport. Death was confirmed in 5 (9.6%) neonates, all preterm. ConclusionDuring the study period, 52 neonates required medical assistance by HEMS. The 5 infants who died were all preterm. In this cohort, adequate basic life support was implemented immediately after birth either by the attending midwife, EMS, or HEMS on arrival. This suggests that prehospital first responders know the basic skills of neonatal life support.

Epinephrine treatment but not time to ROSC is associated with intestinal injury in patients with cardiac arrest

AimCurrent guidelines suggest the use of epinephrine in patients with cardiac arrest (CA). However, evidence for increased survival in good neurological condition is lacking. In experimental settings, epinephrine-induced impairment of microvascular flow was shown. The aim of our study was to analyze the association between epinephrine treatment and intestinal injury in patients after CA. MethodsWe have included 52 patients with return of spontaneous circulation (ROSC) after CA admitted to our medical intensive care unit (ICU). Blood was taken on admission and levels of circulating intestinal fatty acid binding protein (iFABP) were analyzed. ResultsPatients were 64 (49.8–73.8) years old and predominantly male (76.9%). After six months, 50% of patients died and 38.5% of patients had a cerebral performance category (CPC)-score of 1–2. iFABP levels were lower in survivors (234 IQR 90–399 pg/mL) as compared to non-survivors (283, IQR 86–11500 pg/mL; p < 0.05). Plasma levels of iFABP were not associated with time to ROSC but correlated with epinephrine-dose (R = 0.32; p < 0.05). 40% of patients receiving ≥3 mg of epinephrine as compared to 10.5% of patients treated with <3 mg (p < 0.05) developed iFABP plasma levels >1500 pg/mL, which was associated with dramatically increased mortality (HR4.87, 95%CI 1.95–12.1; p < 0.001). iFABP levels predicted mortality independent from time to ROSC and the disease severity score SAPS II. In contrast to mortality, iFABP plasma levels were not associated with neurological outcome. ConclusionsIn this small, single centre study, cumulative dose of epinephrine used in cardiac arrest patients was associated with an increase in biomarker indicative of intestinal injury and 6-month mortality.

Loss of consciousness at onset of aneurysmal subarachnoid hemorrhage in good-grade patients.

Loss of consciousness (LOC) at presentation with aneurysmal subarachnoid hemorrhage (aSAH) has been associated with early brain injury and poor functional outcome. The impact of LOC on the clinical course after aSAH deserves further exploration. A retrospective analysis of 149 aSAH patients who were prospectively enrolled in the Cerebral Aneurysm Renin Angiotensin Study (CARAS) between 2012 and 2015 was performed. The impact of LOC was analyzed with emphasis on patients presenting in excellent or good neurological condition (Hunt and Hess 1 and 2). A total of 50/149 aSAH patients (33.6%) experienced LOC at presentation. Loss of consciousness was associated with severity of neurological condition upon admission (Hunt and Hess, World Federation of Neurosurgical Societies (WFNS), Glasgow Coma Scale (GCS) grade), hemorrhage burden on initial head CT (Fisher CT grade), acute hydrocephalus, cardiac instability, and nosocomial infection. Of Hunt and Hess grade 1 and 2 patients, 21/84 (25.0%) suffered LOC at presentation. Cardiac instability and nosocomial infection were significantly more frequent in these patients. In multivariable analysis, LOC was the predominant predictor of cardiac instability and nosocomial infection. Loss of consciousness at presentation with aSAH is associated with an increased rate of complications, even in good-grade patients. The presence of LOC may identify good-grade patients at risk for complications such as cardiac instability and nosocomial infection.

Long-term survival of a patient suffering from glioblastoma multiforme of the brain as well as kidney cancer diagnosed and treated simultaneously

Primary tumors of the brain account for up to 2% of all malignant neoplasms. The average life expectancy for patients with malignant gliomas of the brain is 12. 6 months. Glioblastoma multiforme is the most common one. Most patients diagnosed with it die within the first two years after the date of diagnosis. Only 2% of all cases survive for more than 36 months. Renal cell carcinoma (RCC) accounts for 2–3% of all malignant neoplasms in adults. The incidence of RCC, at all levels of advancement, has increased in recent years, resulting in increased mortality. Average survival with this diagnosis is about 50% and depends on the severity of the disease. We present the case of a 62-year-old patient, who has survived for many years after radical treatment of glioblastoma multiforme of the brain. The patient was simultaneously diagnosed with kidney cancer. Before the final diagnosis was given, a detailed diagnostic process had been carried out at several medical institutions. The diagnostics were initiated as a result of an epileptic seizure that had occurred for the first time in the patient’s life. Radiological examination led to the suspicion of metastases to the brain as well as a tumor of the right kidney. The treatment started with surgery of the brain tumor. Afterward, radical removal of the right kidney was performed. After obtaining the final histopathological results from the brain tumor histopathological preparations were consulted in another city and medical center. Next, the patient received complementary radiotherapy to the site of tumor removal, combined with temozolomide and continuation of chemotherapy after irradiation was finished. The treatment of the kidney cancer was finalized with a surgery. To date, the patient has survived for more than six years without relapse or neoplastic dissemination, in very good general and neurological condition. The case analysis allows for identifying, in the patient, several prognostic factors of long-term survival, such as: the relatively young age of the patient when the disease was diagnosed, good general and neurological condition before treatment, small size of the tumor, radical surgical treatment, location of the tumor outside of the lateral ventricles, no contact of the tumor with the subventricular zone of the brain (SVZ), as well as the low HDL (high-density lipoprotein) and LDL (low-density lipoprotein) levels in biochemical blood tests before surgery of the brain tumor.

Outcome after pre-hospital cardiac arrest in accordance with underlying cause

AimIn terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry. MethodsAll pre-hospital cardiopulmonary resuscitations (CPR) documented in the German Resuscitation Registry between 2007 and 2017 were retrospectively investigated with regard to cause of cardiac arrest, return of spontaneous circulation (ROSC), and hospital discharge rate with good neurological outcome. To avoid selection bias, only rescue services with a return rate in the form ‘further clinical treatment’ of >30% were included, this resulted in a total return rate of 84% of the included data. ResultsIn total, 33,772 patients were included. The most common causes of OHCA were cardiac events (62.2%), hypoxia (11.1%) and trauma (3.2%), in 17.2% no or unknown cause were documented. Overall, 44.8% of patients achieved ROSC, 13.1% of patients were discharged alive from hospital and 68.3% of these were in good neurological condition (9.0% of all patients). ROSC rates differed between 8.9% (sudden infant death syndrome) and 64.4% (intracranial bleeding), while discharge rates with good neurological outcome ranged between 0.9% (sepsis) and 14.0% (intoxication). ConclusionThe most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.

Cerebral Aneurysms Differ in Patients with Hysterectomies

Female sex is a well-known risk factor for aneurysm formation. Although the role of the ovaries and estrogen in aneurysm development has been supported, other organ-hormone pairs unique between sexes also may be implicated. In this study, we aimed to determine whether intracranial aneurysms microsurgically clipped in patients with previous hysterectomies exhibit any uniqueaneurysm characteristics from those without hysterectomies. Solitary aneurysms microsurgically treated by the senior author (M.T.L.) were included from a database of patients treated between January 2010 and April 2013 at a tertiary academic medical center. Only female patients and patients equal or older in age to the youngest patient in the hysterectomy group were included in the control group. Patient and aneurysm characteristics were compared using the χ2 test for categorical variables and the independent t test analysis for continuous variables. A total 233 patients were included in the study. Forty-three patients (19%) had undergone a previous hysterectomy; none had oophorectomies recorded. No difference in mean age (P= 0.89), hypertension (P= 0.38), alcohol use (P= 0.87), tobacco use (P= 0.22), or aneurysm location (P= 1) existed. However, patients in the hysterectomy group more often presented in a good neurologic condition before surgery (88% vs. 74%, P=0.04) and had fewer large aneurysms (8% vs. 24%, P=0.03). Also, fewer presented with a ruptured aneurysm (28%) then the nonhysterectomy group (51%) (P= 0.004). Female patients with a surgical history of a hysterectomy have a lower rate of large aneurysms, present in better neurologic condition, and are less likely to present with a ruptured aneurysm than females without a hysterectomy.

Long-term effects of brief hypoxia due to cardiac arrest: Hippocampal reductions and memory deficits

ObjectiveTo examine the effects of brief hypoxia (<7 min) due to cardiac arrest on the integrity of the brain and performance on memory and executive functions tasks. MethodsPatients after out-of-hospital cardiac arrest (CA) (n = 9), who were deemed neurologically intact on discharge, were compared to matched patients with myocardial infarction (MI) (n = 9). A battery of clinical and experimental memory and executive functions neuropsychological tests were administered and MRI scans for all patients were collected. Measures of subcortical and cortical volumes and cortical thickness were obtained using FreeSurfer. Manual segmentations of the hippocampus were also performed. APACHE-II scores were calculated based on metrics collected at admission to ICCU for all patients. ResultsSignificant differences between the two groups were observed on several verbal memory tests. Both hippocampi were significantly reduced (p < 0.05) in the CA patients, relative to MI patients. Hippocampal subfields segmentation showed significantly reduced presubiculum volumes bilaterally. CA patients had on average 10% reduction in volumes bilaterally across hippocampal subfields. No cortical thickness differences survived correction. Significant correlations were observed in the CA group only between the hippocampal volumes and performance on verbal memory tasks, including recollection. Hippocampal volumes and several memory measures (but not other cognitive domains) were strongly correlated with APACHE-II scores on admission in the CA group, but not in the MI group ConclusionsChronic patients with cardiac arrest who were discharged from hospital in “good neurological condition” showed an average of 10% reduction in hippocampal volume bilaterally and significant verbal memory deficits relative to matched controls with myocardial infarction, suggesting even brief hypoxic periods suffice to lead to specific hippocampal damage.

Quality of life and posttraumatic stress disorder after out-of-hospital cardiac arrest

Survival rate after out-of-hospital cardiac arrest (OHCA) is increasing. However, there is alack of data concerning long-term quality of life of affected patients. This study aims to investigate the psychological effects of out-of-hospital cardiopulmonary resuscitation. All patients who were admitted to our hospital after OHCA between 01January2008 and 30June2015 and could be discharged in good neurological condition were asked to fill out the Impact of Event Scale-Revised (IES-R) and 36-Item Short Form Health Survey (SF-36). For statistical analysis, the mean, standard deviation and student's t‑test were used (level of significance p< 0.05). Of 280 OHCA survivors, 56patients (20.0%) were discharged from the hospital in good neurological condition. Of those, 20patients (35.7%) were willing to participate in this study, among them 11women and 9men. Compared to the cohort of the German normative data, the results of the SF-36 questionnaire of OHCA survivors showed significantly lower values in all SF-36 subscales and also for the summary scores. There was no significant difference compared to patients with myocardial infarction. Average values of the IES-R subscales for intrusion and avoidance were 9.9± 9.3 and 9.7± 7.7, respectively, and 11.3± 7.4 for hyperarousal. Calculations indicated the suspected diagnosis of posttraumatic stress disorder in 2of the 20patients (10%). Even in patients who could be discharged from the hospital after OHCA in good neurological condition, the quality of life is significantly lower compared to the standard population but not compared to patients with myocardial infarction. The data also suggest that arelevant number of patients after OHCA is affected by posttraumatic stress disorder. Further research efforts on optimization of post-resuscitation care should not only focus on survival rates but also on improving quality of life.

Ruptured middle cerebral artery aneurysms with a concomitant intraparenchymal hematoma: the role of hematoma volume

PurposeTo study whether clinical outcome data from our patient cohort could give support to the new recommendation in the AHA/ASA guidelines for the management of aneurysmal subarachnoid hemorrhage that states “that microsurgical clipping may receive increased consideration in patients with ruptured middle cerebral artery (MCA) aneurysms and large (>50 mL) intraparenchymal hematomas”, while clinical outcome data supporting this recommendation are sparse.MethodsWe reviewed the clinical and radiological data of 81 consecutive patients with MCA aneurysms and concomitant hematomas admitted between January 2006 and December 2015. The relation between (semi-automatically quantified) hematoma volume (< or > 50 ml), neurological condition on admission (poor: GCS < 8 or non-reactive pupils), treatment strategies (no treatment, coiling, or clipping with or without decompression and/or clot removal), and outcome (favorable: mRS score 0–3) was evaluated.ResultsClinical outcome data were available for 76 patients. A significant difference in favorable outcome (17 vs 68%) was seen when comparing patients with poor and good neurological condition on admission (p < 0.01). Patients with hematomas > 50 ml had similar outcomes for coiling and clipping, all underwent decompression. Patients with hematomas < 50 ml did not show differences in favorable outcome when comparing coiling and clipping with (33 and 31%) or without decompression (90 and 88%).ConclusionPoor neurological condition on admission, and not large intraparenchymal hematoma volume, was associated with poor clinical outcome. Therefore, even in patients with large hematomas, the neurological condition on admission and the aneurysm configuration seem to be equally important factors to determine the most appropriate treatment strategy.

Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage

Currently, we lack well-established guidelines for the emergency management of severe immune thrombocytopenia (ITP) with life-threatening bleeding. We now report the management of two patients with severe ITP, complicated by substantial cerebral hemorrhage, requiring urgent surgery due to refractory intracranial hypertension. To rapidly boost platelet counts (PCs), corticosteroids, intravenous immunoglobulin, and iterative platelet transfusions were given; all were ineffectual. Romiplostim, a thrombopoietin receptor agonist, was then administered as an “on demand therapy,” with the result that a rapid and sustained increase of PCs was achieved, thus allowing for postoperative hemostasis. Both patients recovered good neurological condition, suggesting the potential utility of romiplostim, in combined therapy, for the emergency management of severe ITP.

Biotin-Thiamine-Responsive Basal Ganglia Disease: Case Report and Follow-Up of a Patient With Poor Compliance.

Background:Biotin-thiamine-responsive basal ganglia disease (BTBGD) is a rare treatable autosomal recessive neurometabolic disorder characterized by progressive encephalopathy that eventually leads to severe disability and death if not treated with biotin and thiamine supplements.Objectives:We aimed to determine the optimal management of BTBGD presenting in acute encephalopathic episodes.Method:Case report.Results:An 8-year-old girl born to consanguineous parents was diagnosed with BTBGD at the age of 3 years after presenting with acute encephalopathy and ataxia. The patient was treated with biotin and thiamine, and the family was instructed to continue these medications for life. When she was 7 years old, her supplements were stopped for 2 weeks for social reasons. Afterward, the patient began to have tremor in both hands and an unsteady gait. The family then resumed the medications at the usual dosages. However, the patient remained symptomatic. The patient was admitted with acute BTBGD because of discontinuation of medications. The patient’s condition was then managed with high doses of intravenous thiamine and oral biotin. She showed gradual improvement after 48 hours. She was then discharged home 1 week later with residual mild upper and lower limb tremor, as well as right lower limb dystonia. Further follow-up showed a good neurological condition with no apparent long-term sequel. The family was further educated about the importance of strict compliance.Conclusion:Patients with BTBGD should remain on lifelong treatment with thiamine and biotin. For those who present with acute relapse, we recommend inpatient treatment with high doses of intravenous thiamine and oral biotin. Further clinical research is required to determine the optimal doses and durations.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support

PurposeVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. Materials and methodsA retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1–2). ResultsThere were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPR patients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CS patients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPR patients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition. ConclusionThe initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes.

Cardiac arrest center – One-year experience of the Regional Hospital Liberec

IntroductionOut-of-hospital cardiac arrest (OHCA) is one of the most common causes of death in the adult population in developed countries. Centralization of post-resuscitation care may improve the patients’ prognosis. Expert statement of the Czech Society of Cardiology recommends the establishment of cardiac arrest centers using the infrastructure of existing tertiary cardiac centers. The introduction of this system in the region of Liberec started in April 2016. The aim of our work is to present the one-year results compared to the results from previous years. MethodsAll patients treated in the Department of Cardiology of Regional Hospital Liberec after OHCA from 1st April 2016 to 1st April 2017 were enrolled consecutively. Neurological status and mortality were evaluated for the time period of 30 days from the day of admission. The data were compared to the registry of patients hospitalized in the same department after OHCA and successful resuscitation from 1st January 2013 to 31st November 2015. ResultsAfter the establishment of the Cardiac Arrest Centre, an increase of primarily transported patients of 39.5% (0.81 vs. 1.13 patient per week) was observed. There was a statistically significant increase in the proportion of patients with non-shockable rhythm (25.2 vs. 42.6%, p: 0.013). Despite this, the proportion of patients with cardiovascular etiology of cardiac arrest did not change (71.4 vs. 77.0%). There was also no reduction in the proportion of patients with acute coronary syndrome (47.6 vs. 44.3%). There was no statistically significant change of proportion of patients undergoing selective coronarography (63.9 vs. 54.1%) and percutaneous coronary intervention (35.4 vs. 36.1%). There was an increase in 30-day mortality, which was not statistically significant (36.7 vs. 49.2%, p: 0.096). Most of the surviving patients (75.4 vs. 71.0%) were in a good neurological condition. ConclusionCentralization of post cardiac arrest care using previously established infrastructure is feasible in our region. Furthermore, it resulted in the increase of directly transported patients and led to the increase of the total number of patients admitted without increasing the proportion of patients with a non-cardiac cause of OHCA. There was no significant change in mortality and neurological outcome.

Local anaesthesia with analgosedation in patients qualified for transcatheter aortic valve implantation (TAVI): first institute's results and experiments.

The authors present their own experience of the treatment of patients qualified for transcatheter aortic valve implantation (TAVI) carried out in a modern hybrid operating room. The objective of the present study was to demonstrate the initial results of conducting anaesthesia in high-risk patients qualified for the TAVI procedure (transcatheter aortic valve implantation). In addition, the authors' aim was also to point out to the special challenges of an anaesthesiologist conducting local anaesthesia in such a type of procedures and to evaluate the safety and efficacy of the TAVI procedure conducted under remifentanil analgosedation. A retrospective analysis included patients treated during the period from September 2015, when local anaesthesia for the transcatheter aortic valve implantation was used for the first time at our centre, up to February 2016. The studied population consisted of 11 patients treated for severe aortic valve stenosis. The mean age of patients was 80 ± 7 years. Three patients were men (27%) and eight were women (73%). The study included all subsequent patients (n = 11), treated in our centre, for whom it was decided to perform TAVI under local anaesthesia. The total hospital mortality rate was 0%. All procedures were performed in a hybrid operating room. Despite the complications observed in the described group, the hospital mortality rate during TAVI was 0%. All patients, after 12 ± 5 days of treatment, left the hospital in a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale) and GCS-15 (Glasgow Coma Scale) scales. With an ejection fraction of the left ventricle of 53 ± 11%, the transcatheter aortic valve was successfully implanted. Percutaneous aortic valve implantation can be successfully conducted under remifentanil analgosedation. TAVI procedures should be performed in the conditions of a modern, well-equipped hybrid room. The aim of the anaesthesiologist should consist of conducting the least invasive anaesthesia/analgesia, bearing in mind the safety and comfort of the patient.

Neurocognitive status in patients with newly-diagnosed brain tumors in good neurological condition: The impact of tumor type, volume, and location

ObjectiveNeurocognitive function is of great importance in patients with brain tumors. Even patients in good neurological condition may suffer from neurocognitive dysfunction that affects their daily living. The purpose of the present study was to identify risk factors for neurocognitive dysfunction in patients suffering from common supratentorial brain tumors with minor neurological deficits. MethodsA prospective study evaluating neurocognitive dysfunction in patients with a newly-diagnosed brain tumor in good neurological condition was performed at a major German academic institution. Patients underwent extensive neurocognitive testing assessing perceptual speed, executive function, visual-spatial and verbal working memory, short- and long-term memory, verbal fluency, fluid intelligence, anxiety, and depression. For each patient, a healthy control was pair-matched based on age, sex, handedness, and profession. ResultsA total of 46 patients and 46 healthy controls underwent neurocognitive testing. Patients suffered from glioblastoma multiforme (10), cerebral metastasis (10), pituitary adenoma (13), or meningioma (13). There was neither any difference in age, educational level, fluid intelligence, neurological deficits, and anxiety nor in any depression scores between tumor subgroups. Overall, neurocognitive performance was significantly worse in patients compared to healthy controls. Larger tumor volume, frontal location, and left/dominant hemisphere were associated with worse executive functioning and verbal fluency. Additionally, larger tumors and left/dominant location correlated with impairments on perceptual speed tasks. Frontal tumor location was related to worse performance in visual-spatial and short- and long-term memory. Tumor type, clinical presentation, and patient self-awareness were not associated with specific neurocognitive impairments. ConclusionsPatients suffering from newly-diagnosed brain tumors presenting in good neurological condition display neurocognitive impairments in various domains. Larger tumor volumes, frontal location, and left/dominant hemisphere are important predictors for potential neurocognitive deficits. Tumor type, clinical presentation, or self-awareness are less significant at the time of diagnosis.

Emergency extracorporeal life support and ongoing resuscitation: a retrospective comparison for refractory out-of-hospital cardiac arrest

BackgroundIn refractory cardiac arrest, with cardiopulmonary resuscitation (CPR) for more than 30 min, chances of survival are small. Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for certain patients with cardiac...