Resuscitation Research Articles

Dimethyl malonate slows succinate accumulation and preserves cardiac function in a swine model of hemorrhagic shock.

Succinate (SI) is a citric acid cycle metabolite that accumulates in tissues during hemorrhagic shock (HS) due to electron transport chain uncoupling. Dimethyl malonate (DMM) is a competitive inhibitor of SI dehydrogenase, which has been shown to reduce SI accumulation and protect against reperfusion injury. Whether DMM can be therapeutic after severe HS is unknown. We hypothesized that DMM would prevent SI buildup during resuscitation (RES) in a swine model of HS, leading to better physiological recovery after RES. The carotid arteries of Yorkshire pigs were cannulated with a 5-Fr catheter. After placement of a Swan-Ganz catheter and femoral arterial line, the carotid catheters were opened and the animals were exsanguinated to a mean arterial pressure (MAP) of 45 mm. After 30 minutes in the shock state, the animals were resuscitated to a MAP of 60 mm using lactated ringers. A MAP above 60 mm was maintained throughout RES. One group received 10 mg/kg of DMM (n = 6), while the control received sham injections (n = 6). The primary end-point was SI levels. Secondary end-points included cardiac function and lactate. Succinate levels increased from baseline to the 20-minute RES point in control, while the DMM cohort remained unchanged. The DMM group required less intravenous fluid to maintain a MAP above 60 (450.0 vs. 229.0 mL; p = 0.01). The DMM group had higher pulmonary capillary wedge pressure at the 20-minute and 40-minute RES points. The DMM group had better recovery of cardiac output and index during RES, while the control had no improvement. While lactate levels were similar, DMM may lead to increased ionized calcium levels. Dimethyl malonate slows SI accumulation during HS and helps preserve cardiac filling pressures and function during RES. In addition, DMM may protect against depletion of ionized calcium. Dimethyl malonate may have therapeutic potential during HS.

Использование симуляционных технологий для формирования компетентности клинических ординаторов и аспирантов в проведении сердечно-легочной реанимации

Цель работы — оценка эффективности симуляционных технологий в процессе формирования и поддержания у клинических ординаторов и аспирантов практических навыков сердечно-легочной реанимации и компетенций оказания неотложной помощи. Был проведен проспективный анализ обучения и усвоения теоретических знаний и практических навыков по проведению сердечно-легочной реанимации клиническими ординаторами и аспирантами. Установлено, что симуляционные формы обучения с использованием современных манекенов способствуют быстрому, эффективному и безопасному формированию у слушателей курса как технических, так и нетехнических навыков оказания неотложной помощи.

Early or Delayed Angiography After Cardiac Arrest? Results at 1 Year

Whether and when to perform coronary angiography in patients successfully resuscitated from out-of-hospital cardiac arrest remain controversial. The

Nurses felt powerless to challenge resuscitation notices

Nurses felt powerless to challenge resuscitation notices

Chest compression efficiency for three methods of single-person rescuer infant cardiopulmonary resuscitation

Chest compression efficiency for three methods of single-person rescuer infant cardiopulmonary resuscitation

Establishment of a predictive model for acute respiratory distress syndrome and analysis of its predictive value in critical burn patients

Objective: To establish a predictive model for acute respiratory distress syndrome (ARDS) in critical burn patients with the screened independent risk factors, and to validate its predictive value. Methods: Totally 131 critical burn patients (101 males and 30 females, aged 18-84 years) who met the inclusion criteria were admitted to the Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to December 2019. A retrospective case-control study was conducted. The patients were divided into ARDS group (54 cases) and non-ARDS group (77 cases) according to whether ARDS occurred or not. The statistics of patients in the two groups were recorded including the gender, age, burn index, combination of inhalation injury, smoking history, delayed resuscitation, indwelling nasogastric tube, and complication of sepsis, and the data were statistically analyzed with independent sample t test, chi-square test, and Fisher's exact probability test. The multivariate logistic regression analysis was performed on the indicators with statistically significant differences between the two groups to screen the independent risk factors for developing ARDS in critical burn patients, and the corresponding nomograph prediction model for the risk of ARDS in critical burn patients was established. The risk scores for patients developing ARDS were therefore obtained based on the above-mentioned nomograph, and the corresponding receiver operating characteristic (ROC) curve was drawn to calculate the area under the curve. The internal validation of the above-mentioned ARDS prediction model was performed using the Bootstrap method, and the area under the ROC curve was calculated for modeling group (79 cases) and validation group (52 cases), respectively. A calibration curve was drawn to assess the predictive conformity of the above-mentioned ARDS prediction model for the occurrence of ARDS in critical burn patients. Results: The burn index, proportion of combination of inhalation injury, and proportion of complication of sepsis of patients were significantly higher in ARDS group than in non-ARDS group (t=0.36, χ2=33.78, 49.92, P<0.01). The gender, age, smoking history, delayed resuscitation, and indwelling nasogastric tube of patients in ARDS group were close to those in non-ARDS group (P>0.05). The multivariate logistic regression analysis showed that the burn index, combination of inhalation injury, and complication of sepsis were the independent risk factors for developing ARDS in critical burn patients (odds ratio=1.05, 15.33, 5.02, 95% confidence interval=1.01-1.10, 2.65-88.42, 1.28-19.71, P<0.05 or P<0.01). The overall area under the ROC curve of the above-mentioned ARDS prediction model was 0.92 (95% confidence interval=0.88-0.97), and the area under the ROC curve was 0.95 and 0.91 (95% confidence interval=0.90-1.00, 0.86-0.97) for validation group and modeling group, respectively. When applying the above-mentioned ARDS prediction model for ARDS incidence prediction, there might be some risk of overestimating ARDS incidence when the prediction probability was <35.0% or >85.0%, and some risk of underestimating ARDS incidence when the prediction probability was 35.0%-85.0%. Conclusions: The burn index, inhalation injury, and sepsis are the independent risk factors for the occurrence of ARDS in critical burn patients. The risk prediction model for ARDS based on these three indicators has good predictive ability for ARDS in critical burn patients.

Influences of hands-only cardiopulmonary resuscitation on lumbar muscle tone, stiffness, and fatigue in emergency medical technicians

Influences of hands-only cardiopulmonary resuscitation on lumbar muscle tone, stiffness, and fatigue in emergency medical technicians

Evaluation accessibility of emergency care for traumatic children in emergency departments in Tabriz University of Medical Sciences, Tabriz, Iran

Background: Emergency care of traumatic children is an important health subject. The aim of this study was to evaluate the accessibility of emergency care for traumatic children in terms of management equipment, cause defects, and familiarity of medical staff with training programs. Methods: All general hospital emergency department in East Azerbaijan province were evaluated based on the checklists with 4 sections and 20 items which rated according to Likert scale from very high ranking (three scores) to very low ranking (zero sore) over 2018. For a score less than 3, defect causes were explained in 7 categories. The staff training certificate courses are considered for pediatric early and advanced life support in an emergency. Also, the staff training certificate in terms of early and advanced resuscitation of children was surveyed. Data were analyzed by SPSS.21. Results: For 20 emergency hospitals, more than 50% equipped with adequate airway instruments. All of the emergencies were provided oxygen therapy equipment, but more than 70% had no chest tube and ventilator fit for children. More than 70% of them had cardiac monitoring and a sphygmomanometer for pediatric patients; however, less than 50% have a blood transfusion set and a urinary catheter. Only two hospitals had held early and advanced pediatric resuscitation workshops for staff. Conclusions: This study showed that 19 (95% ) of emergencies had the potential for early diagnosis and treatment of traumatic children. In contrast, 2 (10%) of staff emergencies had enough work experience in this issue. It is necessary to implement training programs for the familiarity of medical staff with pediatric early and advanced life support in emergency departments.

Sudden unexpected postnatal collapse in a neonate

A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.

Expert consensus on multidisciplinary management of intra-abdominal infections

Intra-abdominal infections(IAIs) are common surgical emergencies and complications, which usually need multidisciplinary management including surgeons, intensivists, infectious disease experts, microbiologists, and clinical pharmacists. Based on international and domestic guidelines and recent advances, a number of experts' statements of consensus, with a problem-oriented approach, were made on the cornerstones of effective treatment of IAIs such as early recognition, etiology identification, adequate source control, and appropriate antimicrobial therapy. Main recommendations include concepts of intra-abdominal infection, pathoqen diagnosis precautions; surgical intervention principles and strategies of specific causes including acute appendicitis, upper gastrointestinal perforation, lower gastrointestinal perforation, acute biliary infection, liver abscess, severe acute pancreatitis, pancreatic fistula, biliary fistula, anastomotic leakage, gastrointestinal perforation, as well as perforation due to endoscopic procedure etc.; principles of antimicrobial therapy, dosage of antibiotics in specific population and pathophysiological state; and systematic support of severe infection such as early resuscitation and nutrition support.

Patients with COVID-19 Are Unlikely to Survive In-Hospital Cardiac Arrest

Early in the COVID-19 pandemic, experts debated about whether cardiopulmonary resuscitation (CPR) should be offered to critically ill patients with

Anesthesia management for cesarean section during coronavirus disease 2019 epidemic

Thirty-six puerperas who underwent emergency cesarean section at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 24, 2020 to February 9, 2020, who all wore medical surgical masks, were retrospectively included in this study Anesthesia management was performed under tertiary medical protection measures A dedicated anesthesia equipment was separately sterilized Narcotic drugs were used for one patient only, and disposable medical supplies were used for anesthetic supplies Contact transmission should be avoided when a neonate required resuscitation, and early isolation and nucleic acid testing were provided for the neonates The rate of suspected cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 11% , and the rate of clinically diagnosed cases was 17% before surgery The rate of clinically diagnosed cases of SARS-CoV-2 was 22%, the rate of confirmed cases was 8%, and the total positive rate of diagnosis was 31% after surgery The rate of neuraxial anesthesia was 86%, the rate of general anesthesia was 14%, the time of spinal puncture was (15±7) min, the time of tracheal intubation under general anesthesia was (2 1±1 3) min, the operation time was (95±36) min, and blood loss was (276±166) ml The Apgar score of newborns was 8 8±0 5 There was 1 neonate whose mother was diagnosed as having coronavirus disease 2019 after operation, an oropharyngeal swab specimen was obtained at 36 h of birth, and the swab was tested positive for SARS-CoV-2 by nucleic acid testing As of February 10, 2020, an anesthesiologist involved in the operation was diagnosed to have infection by SARS-CoV-2 In conclusion, diagnosis of coronavirus disease 2019 during pregnancy is more difficult, it is necessary to perform anesthesia management for cesarean section under tertiary medical protection Although the difficulty in anesthesia operation is increased under tertiary medical protection, anesthesiologists can carry out standardized anesthesia management and guarantee the safety of maternal and infants and anesthesiologists themselves as long as they are rigorously trained and adhere to protective protocols © 2020 Chinese Medical Association

Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Resuscitation in Ayurveda with Reference to Care of Newborn

Resuscitation in Ayurveda with Reference to Care of Newborn

Triple-tube drainage versus jejunal serosal patch for management of releaked perforated duodenal ulcer after initial omental patch repair

Background Perforated duodenal ulcer (DU) is a dangerous and life-threatening condition, with associated high mortality, especially when there is releakage after initial repair with omental patch. There are multiple methods recommended by different studies for its management. These methods include cholecystoduodenoplasty, a jejunal serosal patch, triple-tube drainage, T-tube duodenostomy, and conservative methods. The aim of the study is to compare between triple-tube drainage and jejunal serosal patch as methods of management of releaked DU regarding the efficacy, failure, and mortality. Patients and methods This study included 20 patients presented with releaked perforated DU treated initially with pedicled omental patch technique. They were divided randomly into two groups: group A included 10 patients who were treated by triple-tube drainage and group B included 10 patients who were treated by jejuna serosal patch. Results The mean age of group A patients was 54 years, whereas for group B patients, it was 51 years. Most of the group A patients were males (80%) and also 90% of the group B patients were males. All patients (100%) of both groups were presented with manifestations of shock like hypotension and palpitation. The average length of hospital stay was 11 days (range, 8–15 days) for the group A patients and 13 days (range, 7–19 days) for group B patients. Conclusion Releaked perforated DU after initial omental patch repair is a life-threatening entity and needs urgent resuscitation and interference. There are several methods of its management, among them are triple-tube drainage and jejunal serosal patch. Both methods have nearly the same success, complications, and mortality rates.

Expert consensus on the prevention and treatment of drowning in children

Drowning is a leading cause of accidental injury in children and has a great impact on family and society. The prevention and treatment of drowning is of great importance for reducing mortality rate. This consensus reviews the literature on the epidemiology, rescue, resuscitation, and acute clinical management and prevention of drowning. The panel determines the score of available evidence according to the criteria of Oxford Centre for Evidence-Based Medicine and then makes recommendations on evidence based on such criteria, so as to provide a basis for further reducing the mortality and disability rates caused by drowning.

Correction: Optimal paramedic numbers in resuscitation of patients with out-of-hospital cardiac arrest: A randomized controlled study in a simulation setting

[This corrects the article DOI: 10.1371/journal.pone.0235315.].

129: A Novel Protocol for the Management of Diabetic Ketoacidosis in COVID-19-Infected Patients

INTRODUCTION: In early March 2020, COVID-19 spread in New York City This paper shows trends of rising cases of DKA associated with a worsening COVID-19 pandemic in New York City With the potential for such a large number of DKA patients, our institution found a need for revised glycemic management protocol We discuss how a multidisciplinary team designed a protocol to care for patients with COVID-19 infection and DKA METHODS: Five of The Mount Sinai Health System's EDs are on a shared electronic health record system (Epic Systems, Verona, WI) Deidentified visit data extracted for routine quality review was made available for analysis We looked at total visits and select visit diagnoses related to DKA through March, April and May 2019 and compared those counts to the same period in 2020 Our protocol was developed by stakeholders in a multidisciplinary hospital team We focused on the basic tenets of DKA management: insulin therapy, fluid resuscitation, and electrolyte repletion RESULTS: A total of 93,218 visits were recorded across the five EDs from March 1-May 31, 2019 During that period there were 106 diagnoses of DKA made in the EDs (0 114% of visits) Across the same period in 2020 there were 59,009 visits, and 214 diagnoses of DKA (0 363% of visits) This coincides with the height of the Sars-CoV-2 pandemic in New York City To address this surge, our protocol decreased the frequency of fingerstick monitoring, with changes to insulin dosing allowing admission to non-ICU beds We transitioned from a provider-driven protocol to a nurse-driven protocol to avoid treatment delays due to order placement Insulin infusion rate charts were created to provide nurses guidance on dosing modifications To minimize ARDS risk, our protocol's fluid replacement recommendations lowered resuscitation and replacement rate volumes, adjusting based on provider reassessment Lab values were monitored every 3-4 hours CONCLUSIONS: There is a correlation between the rise of the Sars-CoV-2 pandemic in New York City and a net rise in patients diagnosed with diabetic ketoacidosis We believe our DKA protocol will facilitate safe and effective management of patients with COVID-19 and DKA, reducing the healthcare burden associated with protocols that necessitate frequent treatment modifications and ICU-level care

692: Septic Shock From Sore Throat? Presentation of Streptococcus anginosus Shock and Lemierre Syndrome

INTRODUCTION: Lemierre syndrome is septic thrombophlebitis of internal jugular vein caused by oropharyngeal or head and neck infections The main causative organism is Fusobacterium necrophorum but rarely other organisms such as Staphylococcus aureus, E coli, streptococci, staphylococci, Klebsiella etc can cause the syndrome as well Members of the Streptococcus Anginosus group are rare causes of Lemierre syndrome with very few pediatric case reports in the literature METHODS: A previously healthy 15-year-old female presented with four days of fever, throat pain, abdominal pain and persistent vomiting and was admitted with septic shock requiring extensive fluid resuscitation and vasopressor support Initial labs included WBC 15 2 x 10 9/ L, CRP 34 9 mg/dL, ESR 78 mm/Hr Review of systems was negative for tampon use Rapid streptococcus probe test, respiratory viral panel, and SARS CoV-2 tests were all negative Clindamycin was added to empiric coverage with concern for toxic shock syndrome Within 24 hours of hospitalization, she developed ARDS requiring non-invasive positive pressure ventilation She continued to complain of worsening throat pain and headache CT scan of the neck revealed extensive thrombosis of the left internal jugular and initial blood culture grew Streptococcus constellatus, a member of the S Anginosus group Antibiotic coverage was switched to piperacillin-tazobactam to cover anaerobic organisms such as Fusobacterium as well as Streptococcus Anginosis Enoxaparin was started Lupus antibodies were transiently positive secondary to infection Following discharge, she received intravenous ceftriaxone via PICC line and oral metronidazole for 3 weeks and then oral levofloxacin and metronidazole for 2 weeks She was followed up regularly to assure clearance of septic thrombi from internal jugular vein after 6 weeks of antithrombotic therapy RESULTS: Lemierre syndrome should be considered a diagnosis for an adolescent with throat pain presenting with shock

203: Ischemic Stroke on Multisystem Inflammatory Syndrome Associated With SARS-CoV-2

Cesar, Regina Grigolli1; de Souza, Nelio2; Laporte, Roberta Machado Rissoni3; AndreÍ£o, Marjorie Dias2; de Mendonͧa Neto, Pedro Teles2; Amorim, Fernanda2; Migliori, Leilane2; de Oliveira, Rafael Garcia2; Alves, Ariane Emy Rodrigues2; Homem, Matheus Fischer Severo Cruz2; Badia, Marcelo Matheus2; Palissari, TaÍ s Fernanda2; Somaili, Ibrahim Yahia El2; Coutinho, Bianca2; Fonseca, Thais Suelotto Machado2; de Abreu Neto, Manoel Jacinto2; Gazolli, Jorgiani Andrade2; de Carvalho, Cid Eduardo4; Adda, Adriana Della4 Author Information