Post-cardiopulmonary Resuscitation Research Articles

Hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect neurons from cardiac arrest–induced pyroptosis

JOURNAL/nrgr/04.03/01300535-202504000-00027/figure1/v/2024-07-06T104127Z/r/image-tiff Cardiac arrest can lead to severe neurological impairment as a result of inflammation, mitochondrial dysfunction, and post-cardiopulmonary resuscitation neurological damage. Hypoxic preconditioning has been shown to improve migration and survival of bone marrow–derived mesenchymal stem cells and reduce pyroptosis after cardiac arrest, but the specific mechanisms by which hypoxia-preconditioned bone marrow–derived mesenchymal stem cells protect against brain injury after cardiac arrest are unknown. To this end, we established an in vitro co-culture model of bone marrow–derived mesenchymal stem cells and oxygen–glucose deprived primary neurons and found that hypoxic preconditioning enhanced the protective effect of bone marrow stromal stem cells against neuronal pyroptosis, possibly through inhibition of the MAPK and nuclear factor κB pathways. Subsequently, we transplanted hypoxia-preconditioned bone marrow–derived mesenchymal stem cells into the lateral ventricle after the return of spontaneous circulation in an 8-minute cardiac arrest rat model induced by asphyxia. The results showed that hypoxia-preconditioned bone marrow–derived mesenchymal stem cells significantly reduced cardiac arrest–induced neuronal pyroptosis, oxidative stress, and mitochondrial damage, whereas knockdown of the liver isoform of phosphofructokinase in bone marrow–derived mesenchymal stem cells inhibited these effects. To conclude, hypoxia-preconditioned bone marrow–derived mesenchymal stem cells offer a promising therapeutic approach for neuronal injury following cardiac arrest, and their beneficial effects are potentially associated with increased expression of the liver isoform of phosphofructokinase following hypoxic preconditioning.

Benefits of cardiopulmonary resuscitation in cancer patients.

According to meta-analytic data, the prognosis of a cancer patient post-cardiopulmonary resuscitation (CPR) is relatively similar to the general population. However, preselection of patients, the details of CPR, patient-specific characteristics, and post-CPR care are poorly described. The aim of this study is to identify prognostic factors in order to recognize cancer patient profiles more likely to benefit from CPR. This is a retrospective study on a series of patients with solid or hematological malignancies who received CPR between January 2010 and December 2020 in a cancer institute. Sixty-eight patients were included. The ratio of solid to hematological malignancy was 44/24, of which 32 were metastatic solid tumors. Median age was 61years. Hypoxemia (29%) was the primary factor for cardiac arrest, followed by septic shock (21%). ICU mortality and hospital mortality were 87% and 88% respectively. Younger age, the presence of hematological malignancy, or a metastatic solid tumor were poor predictors for in-hospital mortality. Similarly, cardiac arrest in the ICU, as the final consequence of a pathological process, and a resuscitation time of more than 10min have a negative influence on prognosis. This study shows that CPR is a useful intervention in cancer patients, even in the elderly patient, especially in non-metastatic solid tumors where cardiac arrest is the consequence of an acute event and not a terminal process.

A case of pulmonary visceral subpleural hematoma treated by hematoma evacuation during care of post-cardiopulmonary resuscitation

BackgroundThe occurrence of pulmonary visceral subpleural hematoma during care of post-cardiopulmonary resuscitation including chest compressions and anticoagulant and antiplatelet therapies is extremely rare. Also, there are few reports of treatment of visceral subpleural hematoma, most of which are treated by lung resection. Here we describe a rare case that pulmonary visceral subpleural hematoma arose during post-cardiopulmonary resuscitation care and was treated by hematoma evacuation.Case presentationA 58-year-old male with no smoking history and, past medical histories of rheumatoid arthritis, chronic atrial fibrillation, hypertension, diabetes, and dyslipidemia developed ventricular fibrillation due to myocardial infarction and fainted. He received bystander cardiopulmonary resuscitation and defibrillation by the ambulance crew and had return of spontaneous circulation. After transfer to our hospital, the patient underwent percutaneous catheter intervention and stenting with a diagnosis of myocardial infarction, followed by anticoagulant and antiplatelet therapies. On the 8th hospital day, chest radiography suggested right lower lobe pneumonia, and subsequent chest computed tomography revealed pulmonary hematoma in the visceral subpleural area from S6 to S10. Since no improvement was observed in hypoxemia, treatment was considered necessary. First, an attempt at computed tomography-guided drainage of hematoma was made, but insertion of the Pig-tail catheter was difficult due to hardness of the hematoma. Next, evacuation of hematoma was performed on the 13th hospital day. The hematoma was located in the visceral subpleural area and was removed by incising the pleura. TachoSil Tissue Sealing sheet and Polyglycoal acid sheet were applied to the sites of air leakage and oozing after hematoma evacuation. No re-bleeding or air leakage was observed after the treatment, and the patient was discharged on the 26th hospital day after an uneventful course.ConclusionsPulmonary visceral subpleural hematoma may occur during post-cardiopulmonary resuscitation care, including chest compressions and anticoagulant and antiplatelet therapies. In our case, CT-guided puncture and drainage was difficult and surgical treatment by incision of the visceral pleura and hematoma evacuation alone was done successfully.

Analysis of 332 fiberoptic bronchoscopies performed in a respiratory intensive care unit: a retrospective study.

Fiberoptic bronchoscopy (FOB) is widely used in the intensive care unit for diagnostic and therapeutic purposes. Our study aimed to evaluate FOB's indications, complications, and clinical outcomes in our intensive care unit's mechanically ventilated patients and identify the microorganisms grown in bronchoalveolar lavage (BAL) specimens. Between January 1, 2022, and June 30, 2023, a total of 332 FOBs were performed on 178 patients in the respiratory intensive care unit. Patients' mean age was 64±19.4 years. Females accounted for 65 (36.6%) and males accounted for 113 (63.4%) of the cases. Leading diagnoses included pneumonia (59.5%), acute respiratory distress syndrome (ARDS) (20.7%), sepsis (17.9%), chronic obstructive pulmonary disease (COPD) attack (21.9%), pulmonary embolism (10.1%), lung malignancy (43.8%), hemoptysis (8.9%), heart failure (15.1%), neurological/neuromuscular conditions (8.4%), and post cardiopulmonaryresuscitation (CPR) (2.8%). FOB purposes were BAL retrieval (43.6%), secretion clearance (30.4%), guided tracheostomy (11.7%), atelectasis (8.7%), and hemoptysis (5.4%). Hypoxemia marked the primary FOB complication (3.6%). Other issues encompassed hypotension (1.5%), bradycardia (1.2%), bleeding (1.2%), tachycardia (0.9%), and hypertension (0.6%). No statistical significance was found in arterial blood gas pH, arterial partial pressure of oxygen (PaO2), and arterial partial pressure of carbon dioxide (PaCO2) values before and after the FOB procedure (p>0.05). Predominant pathogens in aspiration samples were non-albicans Candida (28.9%), Klebsiella pneumoniae (24.8%), Pseudomonas aeruginosa (14.4%), and Acinetobacter baumannii (11.7%). FOB is an important diagnostic and therapeutic method with a low complication rate when performed by an experienced team with appropriate indication in the intensive care unit.

Post-cardiopulmonary resuscitation care for a patient with decompensated heart failure following cardiac arrest: a case report

Post-cardiopulmonary resuscitation care for a patient with decompensated heart failure following cardiac arrest: a case report

Exploring the Functionality of Technology-driven CPR Training Methodologies Among Healthcare Practitioners: A Randomized Control Pilot Study.

Cardiopulmonary resuscitation training in Malaysia has evolved from traditional to modern approaches, embracing technology for better outcomes. Smartphone-based training apps offer interactive learning with simulations and real-time feedback, improving cardiopulmonary resuscitation skills anytime, anywhere. This study evaluates the effectiveness of the smart-cardiopulmonary resuscitation application for healthcare practitioners. This randomized controlled pilot study was conducted with 30 healthcare practitioners at the University of Malaysia Sabah. Participants underwent a Cardiopulmonary Resuscitation Practical formal educational training program, and data were collected using a Basic Life Support questionnaire and skills assessment checklist sourced from the American Heart Association (2020). Data analysis was conducted utilizing repeated analysis of variance and the Cochran 'Q' test supported by Statistical Package for the Social Sciences statistical software. The control and intervention groups showed improved knowledge and skills from pre-to post-cardiopulmonary resuscitation courses; a significant increase was observed in the intervention group compared to the control group. The F-test indicated a significant time-group effect (F-stat (df) = 16.14 (2), p = 0.01). Cochran's 'Q' test also revealed significant changes in the proportion of healthcare practitioners passing their skills assessments over time (2 = 14.90, control 01). The smart-cardiopulmonary resuscitation application is convenient for refreshing cardiopulmonary resuscitation skills and maintaining proficiency. While it doesn't replace formal cardiopulmonary resuscitation courses, it saves healthcare practitioners and the community time and money. Both groups showed improved cardiopulmonary resuscitation knowledge and skills, with the intervention group using the smart-cardiopulmonary resuscitation application showing higher success rates after two months. Adopting smartphone-based cardiopulmonary resuscitation training with comprehensive content is recommended.

Abstract 18887: Trends and Outcomes of Use of Inotropes in Cardiac Arrest Survivors With Ventriculartachycardia/Fibrillation

Introduction: Cardiac arrest remains a public health crisis with only 10% overall survival rate. Patients with arrest secondary toventricular tachycardia (VT)/ventricular fibrillation (VF) have relatively better survival rates. Post-arrest shock is usuallycardiogenic due to structural defects at baseline. The outcomes of inotrope use in this population is not well known. Hypothesis: We hypothesized that the use of inotropic support is not associated with better survival outcomes. Methods: This is a cohort study of 387 cardiac arrest patients in a tertiary care center enrolled from January 2012 to December2016 who were able to survive for 24 hours post-cardiopulmonary resuscitation after a VT/VF arrest. We compared thebaseline characteristics and 30-day outcomes of cardiac arrest patient who required inotropes and who did not requireinotropes. Results:Out of 338 cardiac arrest survivors with VT/VF arrest, 99 (29.3%) patients were treated with inotropes. 90 (90.9%) ofpatients in the inotrope group were simultaneously on vasopressors. 30-day mortality was higher (67.7%) in theinotrope group compared to patients with no inotrope use (46.2%). The neurological outcome was worse (cerebralperfusion category ≥3) in patients on inotropes (86.9 vs 63.6%). Conclusions: We observed that mortality was higher in VT/VF cardiac arrest survivors who were on inotropes. These patients hadhigher incidence of vasopressor use and were more likely hemodynamically unstable. Further studies are needed toinvestigate the use and outcomes of inotropes in these subsets of patients.

Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study

IntroductionThough early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge.MethodsWe performed a secondary analysis of prospectively collected BP data from the first 24 h following return of circulation from index IHCA events enrolled in the ICU-RESUScitation trial (NCT02837497). The lowest documented systolic BP (SBP) and diastolic BP (DBP) were percentile-adjusted for age, height and sex. Receiver operator characteristic curves and cubic spline analyses controlling for illness category and presence of pre-arrest hypotension were generated exploring the association of lowest post-arrest SBP and DBP with survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). Optimal cutoffs for post-arrest BP thresholds were based on analysis of receiver operator characteristic curves and spline curves. Logistic regression models accounting for illness category and pre-arrest hypotension examined the associations of these thresholds with outcomes.ResultsAmong 693 index events with 0–6 h post-arrest BP data, identified thresholds were: SBP > 10th percentile and DBP > 50th percentile for age, sex and height. Fifty-one percent (n = 352) of subjects had lowest SBP above threshold and 50% (n = 346) had lowest DBP above threshold. SBP and DBP above thresholds were each associated with survival to hospital discharge (SBP: aRR 1.21 [95% CI 1.10, 1.33]; DBP: aRR 1.23 [1.12, 1.34]) and survival to hospital discharge with favorable neurologic outcome (SBP: aRR 1.22 [1.10, 1.35]; DBP: aRR 1.27 [1.15, 1.40]) (all p < 0.001).ConclusionsFollowing pediatric IHCA, subjects had higher rates of survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome when BP targets above a threshold of SBP > 10th percentile for age and DBP > 50th percentile for age during the first 6 h post-arrest.

Basic Life Support Skills for high school students pre and post-cardiopulmonary resuscitation training- An interventional study

Introduction: Immediate Bystander CPR improves the survival outcome of victims experiencing sudden cardiac arrest. Therefore, this study aimed at assessing the emergency preparedness level, training feasibility and knowledge retention of BLS skills among High School students. Materials and Methods: A total of 16 participants were included in the study by convenience sampling method. They were provided with Sudden Cardiac Arrest (SCA) scenario and were asked to perform on a CPR training manikin and assessed using a checklist. Following this session, a theoretical background and hands-on training was given to the students by an AHA certified instructor. This session was concluded by reassessing the participants. A week later, we re-assessed their skill retention. Results: The mean pre-training score was 2.6 (± 1.9). The post-training and one week recall scores was 12.44 (± 0.89) and 12 (±1.05) respectively. We observed a significant difference between the pre- and post-training scores (p&lt;0.001). The post-training score and the one week recall scores were similar which implies that the students have good short term knowledge retention of BLS skills. Conclusion: Knowledge of basic life support skills is low among high school students. They have the ability to learn with good hands-on training and instruction. They also have good retention of the skills one week later.

MIMICKER OF MYOCARDIAL INFARCTION (MI): PHENYLEPHRINE-ASSOCIATED CORONARY VASOSPASM

MIMICKER OF MYOCARDIAL INFARCTION (MI): PHENYLEPHRINE-ASSOCIATED CORONARY VASOSPASM

Admission Pattern and Treatment Outcome in Pediatric Intensive Care Unit, Tertiary Hospital, Addis Ababa, Ethiopia.

Knowledge of the clinical profile and outcomes of critically ill children admitted to Pediatric Intensive Care Unit (PICU) in developing countries aids with the identification of priorities and the resources needed to improve the outcome of critically ill patients. This study aimed to assess the admission pattern, outcomes, and associated factors of patients admitted to the PICU of St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Institutional-based cross-sectional study was done. Data was collected through chart abstraction from patients admitted to the PICU between January 2017 and December 2018. SPSS 20.0 was used to analyze the data. Descriptive statistics, cross-tabulations, and logistic regressions were used. A total of 260 pediatric patients were analyzed. The mean age at admission was 48.13 ± 53.65 months, with M: F ratio of 1.4:1. The mean and median duration of PICU stay was 7.26 ±6.87 days, and 6.0 days respectively. The most commonly affected organ systems were the central nervous system (79, 33.2%) and respiratory system (55, 23.1%). Mechanical ventilation and admission after cardiopulmonary resuscitation (p < 0.001) were independent predictors of mortality. Infectious causes of illnesses were the leading causes of admission and death in the PICU. The mortality rate of our PICU was 21.1 %. In this study, post-cardiopulmonary resuscitation admission and use of mechanical ventilation were statistically significant predictors of mortality indicating the need for well equipping and staffing the PICU to improve the outcome of such critically sick patients.

Difficult Management of Giant Gallstone Ileus of a Post-cardiopulmonary Resuscitation Patient: A Case Report

Gallstone ileus is a rare form of mechanical intestinal obstruction. It is associated with high mortality and morbidity in the elderly population. The treatment of gallstone ileus includes more than one surgical option and it is appropriate to determine the surgical technique according to the general condition of the patient.In our case report, we present an 83-year-old patient who was admitted to the emergency room due to nausea and vomiting, was diagnosed with gallstone ileus, and had a cardiac arrest just before surgery. The patient management and the following surgical approach are also explained in detail.

Effect of educational program on nurses' role during and post CPR in Khartoum state hospitals

Background: Cardiopulmonary resuscitation (CPR) is knowing as the sudden, stopped of heart function and respiratory breathing also is stopped unexpected condition and potentially reversible, clinically manifested by unconsciousness, apnea, weak or absent pulse if not treated within minute leads to death. The nurse is importance to knowing about the intervention when found patient arrested now a day not for medical staff must be knowing regarding of CPR but the general population should be training about how to save arrested person.

Outcome of Extracorporeal Membrane Oxygenation for Pediatric Patients With Neoplasm: An Extracorporeal Life Support Organization Database Study (2000-2019).

This study update in usage and outcomes of pediatric extracorporeal membrane oxygenation (ECMO) for patients with neoplasm analyzed according to demographics, clinical variables, and complications. Retrospective database review of the Extracorporeal Life Support Organization registry from the last 2 decades (2000-2019). The data were divided between two decades in order to compare patients' backgrounds and outcomes over time. ECMO centers reporting to Extracorporeal Life Support Organization. Patients equal to or younger than 18 years old with International Classification of Diseases, 9th Revision and International Classification of Diseases, 10th Revision codes that referred to neoplasms who were managed with ECMO. None. Demographics, cancer subtype, clinical variables, and ECMO complications were assessed in relation to the primary study outcome of survival to hospital discharge. Nine-hundred two patients met inclusion criteria; 699 patients were in the latest decade, which is more than three times the number from the previous decade (203 patients). On univariate analysis, compared with the previous decade, in the later decade, ECMO was more frequently applied in patients with pre-ECMO cardiac arrest (31.3% vs 17.1%; p < 0.001), and/or lower oxygenation index (38.0 vs 48.1; p < 0.001). We failed to identify a difference in survival between the 2 decades (42.8% vs 37.9%; p = 0.218). On multivariable analysis, diagnosis of hematologic malignancy, post-cardiopulmonary resuscitation support type, hematopoietic stem cell transplant, and age older than seven were each associated with greater odds of mortality. The use of ECMO in children with neoplasm has expanded over the latest decade with changes in patient selection. Mortality remains unchanged. Hence, although the clinician still should stay cautious in its application, ECMO can be considered as an option to rescue pediatric oncologic patients in the setting of worsening cardiopulmonary status in the PICU.

The incidence of postoperative cardiac arrest and pre-resuscitation factors associated with post- cardiopulmonary resuscitation mortality: a single-center study in Thailand

Background: The author aimed to determine the incidence of in-hospital postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR), postoperative CPR mortality and pre-resuscitation factors associated with post CPR mortality. Method: A retrospective cohort study was conducted at King Chulalongkorn Memorial Hospital in Thailand from September 2018 through August 2020. A total of 34,590 adult patients underwent surgical procedures under anesthesia were recruited by electronic data recorded review. A subset of patients with postoperative CPR was collected for demographic data, comorbidities, ASA classification, operative time, functional class, types of surgery, postoperative complications, the number of deaths and survival, and SOS score at 4 hours preceding cardiac arrest. Results: A total of 34,590 adult surgical patients were recruited. In-hospital postoperative cardiac arrest incidence was 12 patients per 10,000 surgeries and predominated in emergency operation (28 per 10,000 surgeries; P&lt; 0.0001). Risk ratio of emergency operation resulted in postoperative CPR was 3.15 (95% CI 1.72-5.77; P&lt;0.001). Postoperative cardiac arrest patients aged 64.07 ± 16.58. The BMI was 23.46 ± 5.83. Mostly they were in ASA category 3 (44.2%). Everyone had general anesthetic procedures. The most common comorbidity was hypertension. In-hospital postoperative CPR mortality was 62.8%. Factors possibly predisposed to it were functional class &lt; 4 METS, colorectal surgery and SOS score at 4 hours prior to cardiac arrest of at least 8. Conclusion: Incidence of in-hospital postoperative cardiac arrest and mortality after CPR in the study tended to be lower than that of previous studies. Emergency operations predisposed to cardiac arrest. SOS score was possibly valuable as a prognostication tool, ICU triage, as well as, a part of the early warning score to prevent the overwhelming crisis. Surveillance for patient’s deterioration, effective rapid response system, and comprehensive preoperative rehabilitation should be emphasized.

Short- and Long-Term Outcomes of Hematologic Malignancy Patients After Cardiopulmonary Resuscitation: Experience of a Large Oncology Center.

Purpose:The objective of this study is to describe characteristics and short- and long-term outcomes of patients with hematologic malignancies who received cardiopulmonary resuscitation (CPR).Methods:A retrospective review was conducted of all Code Blues at a large comprehensive cancer center. Demographic, clinical, and outcome variables were analyzed for patients with a hematologic malignancy who underwent CPR.Results:Of 258 patients, 60.1% had leukemia. Outcomes included return of spontaneous circulation (70.2%), hospital survival (12%), and 90-day, 6-month, and 1-year survival rates of 9.8%, 8.2%, and 5.9%, respectively. Factors associated with hospital mortality included establishing a do not resuscitate order after CPR (p < .0001), location of CPR (p = .0004), cause of arrest (p = .0019), requiring vasopressors (p = .0130), mechanical ventilation (p = .0423), and acute renal failure post CPR (p = .0006). Although no difference in hospital survival between leukemia and non-leukemia patients was found, more non-leukemia patients were alive at 90 days (p = .0099), 6 months (p = .0023), and 1 year (p = .0119).Conclusions:Factors including organ dysfunction, location of CPR, and cause of arrest are associated with hospital mortality post CPR. However, immediate survival post CPR does not seem to be affected by a diagnosis of leukemia. These data should assist health care providers with discussions regarding advance care planning and goals of care after cardiac arrest.

Üçüncü Basamak Bir Yoğun Bakım Ünitesinde Bir Yıl Içinde Ölen Hastaların Klinik Özellikleri

Aim: The aim of this study was to find out the clinical characteristics of patients who died within a year in the intensive care unit (ICU) and to find out the association of ICU admission albumin, lactate levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of these patients who died with ICU length of stay.Material and Method: The files of patients who died in the ICU (n:350) between January 2018 and December 2018 were examined retrospectively. The patients’ demographic data and their clinical characteristics, ICU admission types (surgery or medical medicine), the units they were admitted in, reasons for admission, comorbidities, admission albumin and lactate levels, APACHE II scores and ICU length of stay were recorded. The association of patients’ clinical characteristics with ICU length of stay and laboratory values was evaluated. Result: The patients’ mean age was 72.68±12.98 years, mean APACHE II score was 27.0±10.0, mean albumin value was 3.1±0.7 g/dL and mean lactate value was 4.1±3.3 mmol/L. It was found that albumin value was lower in patients admitted to ICU with mechanical ventilator (MV) need (p&amp;lt;0.001), and lactate value and APACHE II score were significantly higher in patients with post-cardiopulmonary resuscitation (p&amp;lt;0.001). Mean ICU length of stay was 28.24 ± 37.53 days. A weak positive correlation (r =0.172, p=0.001) was found between the patients’ length of stay and albumin, and a weak negative correlation was found with the lactat (r = 0.121, p=0.023) and APACHE II scores (r = 0.151, p=0.001). A weak negative correlation was found between the patients’ albumin and lactate (r =0.152, p=0.004), and APACHE II score (r =0.179, p=0.001), as well as a moderate positive correlation between lactate and APACHE II score.Conclusion: Significant association was found between hypoalbuminemia, hyperlactatemia and high APACHE II scores and ICU length of stay in patients who died in ICU. More comprehensive studies are needed to show the effects of this association on effective use of ICUs.

How debriefing post cardiopulmonary arrest and resuscitation can be used to improve training

Debriefing is a form of discussion used in human medicine following significant events, such as cardiopulmonary arrest (CPA) and resuscitation. There are no studies in veterinary medicine specifically exploring the benefits of debriefing post CPA, showing known knowledge gaps. However, there are studies in training for resuscitation and staff resilience that mention debriefing as tools, and there are studies in human medicine that look at different types of debriefing and benefits. This literature review discusses ways in which debriefing may be implemented into a veterinary environment as well as the impact it could have on staff training, wellbeing and patient outcome.

Outcomes of chest wall fixation in cardiopulmonary resuscitation-induced flail chest.

Chest wall injury is a common complication of cardiopulmonary resuscitation. Chest wall fixation of flail chest has been shown to improve outcomes in patients in whom trauma is the primary pathology. Its efficacy in the post-cardiopulmonary resuscitation setting where the primary event is cardiac arrest is yet to be determined. We report outcomes in a series of 4 patients who underwent rib fixation in the setting of cardiopulmonary resuscitation-induced flail chest.

Characteristics and outcomes of cardiac arrest survivors with acute pulmonary embolism

IntroductionThe characteristics and outcomes of patients that suffer cardiac arrest due to acute pulmonary embolism (PE) are not well studied. We compared the characteristics and outcomes of cardiac arrest survivors that suffered PE with other forms of cardiac arrest. MethodsConsecutive cardiac arrest survivors were enrolled that were able to survive for 24 h post cardiopulmonary resuscitation. Diagnosis of PE was confirmed by CT angiogram or high-probability of PE on ventilation perfusion scan after the successful resuscitation from cardiac arrest. Survival curves were examined and predictors of mortality in PE patients were examined in an adjusted Cox proportional hazard model. ResultsAmong the 996 cardiac arrest patients (mean age 62.6 ± 14.8 years, females 39.4%), 87 (8.7%) patients were found to have acute PE. The mortality rate of cardiac arrest survivors with and without acute PE was not significant different (68.3% vs. 64%). There were no significant differences in mortality among PE patients that received thrombolytics versus those who did not. Out of 87 patients, 33 (37.9%) required transfusion and had a bleeding complication. The risk of mortality in PE patients was predicted by older age, female sex, history of diabetes mellitus, end-stage renal disease and use of targeted temperature management. ConclusionCardiac arrest survivors with PE did not have significantly better survival than patients with non-PE related cardiac arrest. In addition, use of thrombolytics did not improve survival but these patients ended up requiring transfusion that could have off set the benefit of thrombolytics.