Risk Of Cardiac Arrest Research Articles

Iatrogenic clozapine intoxication after hospital admission: A case-based rationale for an inpatient pharmacy clozapine monitoring service

BackgroundClozapine must be retitrated after 2 consecutive days or more of missed doses owing to the risk of severe hypotension, bradycardia, and cardiac arrest. However, other important adverse events such as somnolence, sialorrhea, or respiratory depression can occur without severe cardiovascular sequalae. These other unintended consequences are not well characterized in the literature. Three cases are reported, highlighting the concerns for continuing clozapine without retitration after periods of not taking the medication. Implications are discussed as well as how pharmacists can collaborate with other disciplines to mitigate safety risks associated with clozapine for hospitalized patients. Case summariesThe first case highlights the importance of medication reconciliation and verifying adherence before clozapine continuation in the hospital. Waiting for collateral information and missing one dose are safer than unknowingly resuming clozapine. The second case suggests that it may be safer to consider patients with unexplained worsening psychiatric symptoms as nonadherent and even partially reduced clozapine doses after nonadherence may be unsafe. The final case demonstrates the importance assessing comedications (e.g., warfarin, phenytoin) that have available therapeutic drug monitoring to suggest nonadherence. Each case resulted in significant adverse events requiring transfer to a higher level of care or prolonged hospitalization. Practice implicationsContinuation of psychiatric medications when a patient is admitted to the hospital is important to prevent worsening of symptoms. However, assessment of clozapine adherence and confidence in that assessment is crucial to prevent clozapine intoxication, severe hypotension, and even death. Pharmacists are uniquely positioned to assess clozapine adherence and ensure patient safety. A hospital-based service was created at a 2000-bed academic medical center to improve transitions of care when patients are admitted with clozapine. The process was created in collaboration with the psychiatric consultation service. Through this process, pharmacists also complete appropriate hematologic monitoring and ongoing clinical monitoring for adverse events.

Incidence, Outcomes, and Risk Factors for Preincision Cardiac Arrest in Cardiac Surgery Patients.

We examined the incidence, postoperative outcomes, and patient-related factors associated with preincision cardiac arrest in patients undergoing cardiac surgery. We retrospectively examined adult patients undergoing elective or urgent cardiac surgery at the Cleveland Clinic between 2008 and 2019. The incidence of preincision cardiac arrest, defined as arrest between induction of general anesthesia and surgical incision, was reported. In a secondary analysis, we assessed the association between preincision cardiac arrest and major postoperative outcomes. In a tertiary analysis, we used adjusted linear regression models to explore the association between preincision cardiac arrest and prespecified patient risk factors, including severe left main coronary artery stenosis, left ventricular ejection fraction, moderate/severe right ventricular dysfunction, low-flow low-gradient aortic stenosis, and moderate/severe pulmonary hypertension. Preincision cardiac arrests occurred in 75 of 41,238 (incidence of 0.18%; 95% CI, 0.17-0.26) patients who had elective or urgent cardiac surgery. Successful cardiopulmonary resuscitation with return of spontaneous circulation or bridge to cardiopulmonary bypass occurred in 74 of 75 (98.6%) patients. Patients who experienced preincision cardiac arrest had significantly higher in-hospital mortality than those who did not (11% vs 2%; odds ratio [OR] (95% CI), 4.14 (1.94-8.84); P < .001). They were also more likely to suffer postoperative respiratory failure (46% vs 13%; OR [95% CI], 3.94 [2.40-6.47]; P < .001), requirement for renal replacement therapy (11% vs 2%; OR [95% CI], 3.90 [1.82-8.35]; P < .001), neurologic deficit (7% vs 2%; OR [95% CI], 2.49 (1.00-6.21); P = .05), and longer median hospital stay (15 vs 8 days; hazard ratio (HR) [95% CI], 0.68 [0.55-0.85]; P < .001). Reduced left ventricular ejection fraction (per 5% decrease) (OR [95% CI], 1.13 [1.03-1.22]; P = .006) and moderate/severe pulmonary hypertension (OR [95% CI], 3.40 [1.95-5.90]; P < .001) were identified as independent risk factors for cardiac arrest. Cardiac arrest after anesthetic induction is rare in cardiac surgical patients in our investigation. Though most patients are rescued, morbidity and mortality remain higher. Reduced left ventricular ejection fraction and moderate/severe pulmonary hypertension are associated with greater risk for preincision cardiac arrest.

Evaluating the association between pulmonary abnormalities and complications following pediatric hip dysplasia surgery.

Developmental dysplasia of the hip (DDH) encompasses a wide range of abnormal hip development and is a common condition in the pediatric population. Congenital pulmonary abnormalities are typically mild in the pediatric population but can be associated with severe comorbid conditions. The purpose of this study was to analyze the effect of structural pulmonary/airway abnormalities on the incidence of postoperative complications following surgical management of DDH. From 2012 to 2019, the National Surgical Quality Improvement Program-Pediatric database was utilized to identify pediatric patients undergoing surgical treatment for hip dysplasia. Patients were stratified into two groups: patients with a structural pulmonary/airway abnormality and patients without a pulmonary abnormality. Patient demographics, comorbidities, and postoperative complications were compared between the two cohorts with the use of various statistical analyses, including bivariate and multivariate analyses. Of the 10,853 patients who underwent surgical treatment for hip dysplasia, 10,157 patients (93.6%) did not have a structural pulmonary/airway abnormality whereas 696 (6.4%) had an airway abnormality. Following adjustment on multivariate analysis, patients with a structural pulmonary abnormality had an increased risk of cardiac arrest requiring cardiopulmonary resuscitation (OR 2.342; p = 0.045). The results indicated that patients with a structural pulmonary abnormality had an increased risk of cardiac arrest requiring cardiopulmonary resuscitation compared to those without a pulmonary abnormality. Ensuring appropriate preoperative evaluation with a multidisciplinary team and close monitoring postoperatively is important to prevent the risk of severe outcomes in this vulnerable patient population.

Sex‐Specific Arrhythmias Caused by Cardiac Sodium Channel Nav1.5 Mutation Alters Cardiomyocyte Metabolism

IntroductionThe activation of cardiac Nav1.5 sodium channels initiates the action potential in the heart to facilitate coordinated contraction. Mutations in Nav1.5 disrupts the action potential leading to arrhythmic diseases which increases the risk of sudden cardiac arrest. The gain of function Arg222Gln mutation in Nav1.5 disrupts structural interactions during channel activation, creating an aberrant pore leading to excessive cations entering the cardiomyocyte (CM). The chronic arrhythmia resulting from Arg222Gln places prolonged stress on the heart which can trigger adverse metabolic reprogramming. We have generated a mouse model possessing the human Arg222Gln mutation where the males illustrate a significant arrhythmia burden, whereas females appear to be protected. We hypothesize that sex‐specifc metabolic reprogramming could provide an explanation for the observed difference in phenotype.MethodsThe human exon containing the Arg222Gln mutation was knocked into the equivalent mouse locus under the endogenous promoter. Shot‐gun proteomics of total heart lysate was performed using LC‐LC mass spectrometry. Significant proteins were identified with at least two unique peptides and a 5% false discovery rate. Clustering and differentially expressed proteins were analyzed using Metaboanalyst and pathway gene ontological analysis was performed with Cytoscape. Cellular metabolism (oxygen consumption) was measured using isolated adult primary CMs with the Seahorse XFe Analyzer.ResultsAfter filtering, mass spectrometry yielded 1654 identified protein across all four analyzed groups (wild‐type and Arg222Gln of both sexes). Unsupervised clustering of the data using principal component analysis and hierarchical clustering revealed complete segregation of the four groups. Sex status contributed most significantly to data segregation, with secondary (but clear) segregation based on Arg222Gln mutation. Comparing Arg222Gln male versus females, there were 157 upregulated proteins and 231 down regulated proteins (P&lt;0.05, ±2‐fold change). Pathway analysis of the differentially expressed proteins reveal multiple changes in metabolic pathways including fatty acid metabolism, pyruvate metabolism, and lactate metabolism. Basal respiration of the isolated CMs in all four groups were unchanged, however maximal respiratory capacity of Arg222Gln males were significantly lower (116.9±13.5pmol O2/min, P&lt;0.05) compared to the wild‐type males (407.3±16.4pmol O2/min). There were no differences between wild‐type females (451.4±22.4pmol O2/min) and Arg222Gln females (463.2±33.7pmol O2/min).ConclusionWe demonstrate sex‐specific proteomic changes in a mouse model of arrhythmia caused by a gain‐of‐function Nav1.5 mutation. While there were many perturbed pathways in our analysis, metabolic changes featured prominently. Our data suggests that metabolic reprogramming could play a role in the cardioprotection in females or a compensatory detrimental mechanism in males harboring the Arg222Gln mutation. Future experiments will aim to understand how sex affects cardiac metabolism in the context of Arg222Gln, specifically targeting the specific roles of sex hormones.

Congenital Long QT Syndrome.

Congenital long QT syndrome (LQTS) encompasses a group of heritable conditions that are associated with cardiac repolarization dysfunction. Since its initial description in 1957, our understanding of LQTS has increased dramatically. Theprevalence of LQTS is estimated to be ∼1:2,000, with a slight female predominance. The diagnosis of LQTS is based on clinical, electrocardiogram, and genetic factors. Risk stratification of patients with LQTS aims to identify those who are at increased risk of cardiac arrest or sudden cardiac death. Factors including age, sex, QTc interval, and genetic background all contribute to current risk stratification paradigms. The management of LQTS involves conservative measures such as the avoidance of QT-prolonging drugs, pharmacologic measures with nonselective β-blockers, and interventional approaches such as device therapy or left cardiac sympathetic denervation. In general, most forms of exercise are considered safe in adequately treated patients, and implantable cardioverter-defibrillator therapy is reserved for thoseatthe highest risk. This review summarizes our current understanding of LQTS and provides clinicians with a practical approach to diagnosis and management.

PO-640-01 CHARACTERISTICS AND OUTCOMES OF FIRST HOSPITALIZATION FOR CARDIAC ARREST IN PATIENTS WITH KNOWN CARDIOMYOPATHY

Patients with reduced ejection fraction (LVEF≤50%) are at increased risk of cardiac arrest (CA) due to shockable [polymorphic (PVT) and monomorphic (MVT) ventricular tachycardia; ventricular fibrillation (VF)] or non-shockable [pulseless electrical activity (PEA), and Asystole] rhythms.

A Rare Cause of Maternal Cardiac Arrest: Idiopathic Ventricular Fibrillation

Severe preeclampsia is one of the serious hypertensive disorders of pregnancy and is significantly associated with cardiovascular morbidity during delivery. Also, the risk of cardiac arrest is higher in this patients. Sudden cardiac arrest (SCA) usually develops due to ventricular fibrillation (VF) or rapid ventricular tachycardia (VT) in the presence of cardiac pathologies. Idiopathic VF (IVF) is a resuscitated cardiac arrest with documented VF without known cardiac, respiratory, metabolic, toxicological etiology. Maternal cardiac arrest (MCA) is a rare condition but may occur even in the best medical health care systems; fast and specified intervention is required. In this case report, we aimed to present our postpartum patient who developed cardiac arrest due to IVF, which is rare in maternal cardiac arrest, and underwent successful cardiopulmonary resuscitation.

Comparison of early warning scores for predicting clinical deterioration and infection in obstetric patients

BackgroundEarly warning scores are designed to identify hospitalized patients who are at high risk of clinical deterioration. Although many general scores have been developed for the medical-surgical wards, specific scores have also been developed for obstetric patients due to differences in normal vital sign ranges and potential complications in this unique population. The comparative performance of general and obstetric early warning scores for predicting deterioration and infection on the maternal wards is not known.MethodsThis was an observational cohort study at the University of Chicago that included patients hospitalized on obstetric wards from November 2008 to December 2018. Obstetric scores (modified early obstetric warning system (MEOWS), maternal early warning criteria (MEWC), and maternal early warning trigger (MEWT)), paper-based general scores (Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS), and a general score developed using machine learning (electronic Cardiac Arrest Risk Triage (eCART) score) were compared using the area under the receiver operating characteristic score (AUC) for predicting ward to intensive care unit (ICU) transfer and/or death and new infection.ResultsA total of 19,611 patients were included, with 43 (0.2%) experiencing deterioration (ICU transfer and/or death) and 88 (0.4%) experiencing an infection. eCART had the highest discrimination for deterioration (p < 0.05 for all comparisons), with an AUC of 0.86, followed by MEOWS (0.74), NEWS (0.72), MEWC (0.71), MEWS (0.70), and MEWT (0.65). MEWC, MEWT, and MEOWS had higher accuracy than MEWS and NEWS but lower accuracy than eCART at specific cut-off thresholds. For predicting infection, eCART (AUC 0.77) had the highest discrimination.ConclusionsWithin the limitations of our retrospective study, eCART had the highest accuracy for predicting deterioration and infection in our ante- and postpartum patient population. Maternal early warning scores were more accurate than MEWS and NEWS. While institutional choice of an early warning system is complex, our results have important implications for the risk stratification of maternal ward patients, especially since the low prevalence of events means that small improvements in accuracy can lead to large decreases in false alarms.

Feasibility of electrocardiogram screening in the USA prior to high school sport participation

BackgroundSudden cardiac death in young athletes is a catastrophic event with an incidence of 1:40,000–1:80,000. Pre-participation sport screening utilizes a 14-point targeted evaluation. Recently, some states have added an ECG to the traditional history and physical. ObjectivesThe study describes a large-scale ECG screening program for middle and high school students. The aim is to depict important components, partners, and plans that can be adopted by other municipalities to help prevent sudden cardiac arrest in this population. MethodsIn 2019, Brevard County School Board in Florida mandated ECGs before participation in middle and high school sports. They partnered with a non-profit group that provides ECGs for a $20.00 fee. Volunteer pediatric cardiologists interpreted the ECGs. Results were emailed to participants, and abnormal results received a phone call to ensure appropriate follow-up care. ResultsThere were 5877 ECG screenings between 4/1/19–12/31/19 with 3% (199/5877) abnormal: 30% (60/199) ventricular conduction, 26% (51/199) arrhythmias, 13% (25/199) ventricular hypertrophy/chamber enlargement, 11% (21/199) ST-T abnormalities, 8% (16/199) prolonged QTc, 6% (12/199) WPW syndrome, and 4% (7/199) AV conduction and axis deviation. The incidence of critical heart disease with a risk of sudden cardiac arrest was 0.1% (8/5877) in those with a confirmed final diagnosis: 6 who underwent an ablation procedure for WPW syndrome, 1 with gene-positive long QTc, and 1 with left ventricular hypertrophy who is undergoing genetic evaluation for hypertrophic cardiomyopathy. ConclusionsTo our knowledge, this is the first large school district in Florida to mandate this level of cardiovascular screening. This pilot project demonstrates that large volume ECG screening prior to school sport participation is feasible at a low cost when utilizing appropriate manpower and providing access to follow up-care.

Healthy lifestyle factors, cardiovascular comorbidities, and the risk of sudden cardiac arrest: A case-control study in Korea

AimsWe investigated the impact of healthy lifestyle factors and cardiovascular comorbidities for sudden cardiac arrest. MethodsA case-control study, including patients with sudden cardiac arrest aged 20–79 years and community-based 1:2 matched controls, was conducted from September 2017 to December 2020. All participants completed a structured questionnaire. Using multivariable logistic regression, we assessed cardiovascular comorbidities (diabetes, hypertension, dyslipidaemia, myocardial infarction, congestive heart failure, arrhythmia, and stroke) and healthy lifestyle factors (low red meat consumption, low fish consumption, high fruit consumption, high vegetable consumption, current non-smoking, regular exercise, and adequate sleep duration) as sudden cardiac arrest risk factors. ResultsAmong 3027 eligible cases, informed consent was obtained from 949 (31.3%) cases. A total of 1731 controls were enrolled. Cardiovascular comorbidities, except dyslipidaemia, were associated with an increased risk of sudden cardiac arrest, whereas all healthy lifestyle factors were associated with a decreased risk. Relative to patients in the 0–2 healthy lifestyle factors group, the adjusted odds ratio (95% confidence interval) for sudden cardiac arrest was 0.25 (0.16–0.40) in patients with 3 healthy lifestyle factors, 0.08 (0.05–0.13) in patients with 4 healthy lifestyle factors, and 0.04 (0.03–0.06) in patients with over 5 healthy lifestyle factors. When the number of healthy lifestyle factors was analysed as a continuous variable, each additional factor was associated with a significant decrease in the likelihood of sudden cardiac arrest (adjusted odds ratio [95% confidence interval]: 0.41 [0.36–0.46]). ConclusionThe increased risk of sudden cardiac arrest by cardiovascular comorbidities could be significantly reduced with healthy lifestyle factors.

Outcomes of cardiopulmonary resuscitation in patients with pulmonary arterial hypertension.

Over the past 20 years, despite significant advancements in pulmonary arterial hypertension (PAH) medical therapy, many patients require admission to the hospital and are at risk for in‐hospital cardiac arrest (IHCA). Prior data found poor survival in PAH patients after cardiac arrest. The purpose of this study was to explore post‐IHCA outcomes in PAH patients receiving advanced medical therapies. This is a single‐center retrospective study of PAH patients who underwent cardiopulmonary resuscitation for IHCA between July 2005 and May 2021. Patients were identified through an internal cardiac arrest database. Twenty six patients were included. Half of the cohort had idiopathic PAH, with 54% of patients on combination therapy, 27% on monotherapy, and 19% of patients on no therapy. Mean right atrial pressure, mean pulmonary artery pressure, cardiac index, and pulmonary vascular resistance were 13 ± 6 mmHg, 57 ± 13 mmHg, 2.0 ± 0.7 L/min/m2, and 14.5 ± 7.6 Wood units, respectively. Most common etiology of cardiac arrest was circulatory collapse. Initial arrest rhythm in all but one patient was pulseless electrical activity. Six patients (23%) achieved return of spontaneous circulation (ROSC) and one patient (4%) survived to hospital discharge. Rates of ROSC and survival to discharge after IHCA are poor in patients with PAH. Even patients with mild hemodynamics had low likelihood of survival. In patients who are lung transplant candidates, there should be early consideration of extracorporeal support before cardiac arrest.

Sodium channel-blocking anticonvulsants do not increase risk of cardiac arrest

Sodium channel-blocking anticonvulsants do not increase risk of cardiac arrest

Depression and Oxidative Stress Interaction in Stable Coronary Heart Disease

Abstract It was concluded that depression (D) is an independent risk factor for cardiovascular diseases (CVD), and is not related to other previously determined cardiac risk factors. Compared with non-depressed patients, the risk of cardiac arrest increased in less severely depressed patients. D worsens the CVD prognosis by significantly increasing the risk of recurrent coronary heart disease (CHD). Some studies suggest that OS directly increases the risk of D in patients with CVD. Oxidative stress (OS) is considered an emergency mechanism that relates to both CVD and D pathophysiology. The common risk factors increase the production of OS and reduce antioxidant defences, thereby promoting the occurrence and development of interacted ischaemic CVD and D. At present, there is insufficient evidence that routine screening of D in patients with CHD will ultimately help improve the patient’s condition. This review reiterates the need for a multidisciplinary approach, which is necessary to understand, diagnose and then treat this frequent co-morbid condition of CHD and D. Assessment of OS markers could modify risk stratification, diagnosis and prevention and treatment of patients with both CHD and D, in patients with and without previous cardiac history.

Sulfonylureas and the Risk of Ventricular Arrhythmias Among People with Type 2 Diabetes: A Systematic Review of Observational Studies.

Previous studies have suggested an association between sulfonylureas and an increased risk of cardiovascular death among patients with type 2 diabetes. A potential mechanism involves sulfonylurea-induced ventricular arrhythmias (VAs). We conducted a systematic review of observational studies to determine whether the use of sulfonylureas, compared with the use of other antihyperglycemic drugs, is associated with the risk of VA (ventricular tachycardia, ventricular fibrillation, and premature ventricular complexes), cardiac arrest, and sudden cardiac death among patients with type 2 diabetes. Two independent reviewers searched MEDLINE, EMBASE, CINAHL Plus, CENTRAL, and ClinicalTrials.gov from inception to July 2021 for observational studies comparing sulfonylureas vs. other antihyperglycemic therapies or intraclass comparisons of sulfonylureas. Our systematic review included 17 studies (1,607,612 patients). Per Risk Of Bias In Non-randomized Studies of Interventions (ROBINS)-I, there were few high-quality studies (2 studies at moderate risk of bias; 4 at serious risk; and 11 at critical risk). All studies at a moderate or serious risk of bias reporting comparisons with other therapies were consistent with an increased risk of VA. Sulfonylureas were associated with a higher risk of arrhythmia vs. dipeptidyl peptidase-4 inhibitors (adjusted hazard ratio (aHR): 1.52, 95% confidence interval (CI): 1.27-1.80) and of VA vs. metformin (aHR: 1.52, 95% CI: 1.10-2.13). One moderate quality study reported inconsistent results for a composite of cardiac arrest/VA in analyses of US Medicaid claims and Optum claims data. Our systematic review suggests that, among higher-quality observational studies, sulfonylureas are associated with an increased risk of VA. However, we identified few methodologically rigorous studies, underscoring the need for additional real-world studies.

The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis.

It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration of patients when applied in the Emergency Department (ED) or prehospital setting. This systematic review (SR) and meta-analysis assessed the predictive abilities of five commonly used EWS scores (National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS), and Cardiac Arrest Risk Triage (CART)). Outcomes of interest included admission to intensive care unit (ICU), and 3-to-30-day mortality following hospital admission. Using DerSimonian and Laird random-effects models, pooled estimates were calculated according to the EWS score cut-off points, outcomes, and study setting. Risk of bias was evaluated using the Newcastle-Ottawa scale. Meta-regressions investigated between-study heterogeneity. Funnel plots tested for publication bias. The SR is registered in PROSPERO (CRD42020191254). Overall, 11,565 articles were identified, of which 20 were included. In the ED setting, MEWS, and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (95% Confidence Interval (CI) 2.35-6.99) to 6.48 (95% CI 1.83-22.89), p = 0.757. MEWS at a cut-off point ≥3 had a similar DOR when predicting ICU admission (5.54 (95% CI 2.02-15.21)). MEWS ≥5 and NEWS ≥7 had DORs of 3.05 (95% CI 2.00-4.65) and 4.74 (95% CI 4.08-5.50), respectively, when predicting 30-day mortality in patients presenting with sepsis in the ED. In the prehospital setting, the EWS scores significantly predicted 3-day mortality but failed to predict 30-day mortality. EWS scores' predictability of clinical deterioration is improved when the score is applied to patients treated in the hospital setting. However, the high thresholds used and the failure of the scores to predict 30-day mortality make them less suited for use in the prehospital setting.

Predictors of Hospital Admissions for Ventricular Arrhythmia or Cardiac Arrest in Patients With Cardiomyopathy

Although ventricular dysfunction is associated with the occurrence of ventricular arrhythmia (VA), most patients with cardiomyopathy do not experience VA. We therefore investigated other predictors of VA in a large contemporary cohort of patients with cardiomyopathy. All patients at a large academic medical system with left ventricular ejection fraction (LVEF) ≤50% were enrolled at the time of first documented low LVEF. Predictors of hospital admission for VA were examined using multivariable Cox models. The incidence of implantable defibrillator (ICD) placement was also examined. A total of 18,003 patients were enrolled. Over a median follow-up of 3.35years, 389 patients (2.2%) were admitted for VA (304 of 12,037 [2.5%] among patients with LVEF ≤35% vs 85 of 5,966 [1.4%] among those with LVEF 36% to 50%). Predictors of VA hospitalization included lower LVEF (hazard ratio (HR)=1.43 per 10% decrease, p <0.001), the presence of an ICD at baseline (HR=1.63, p=0.010), higher blood glucose (HR=1.02 per 10mg/100ml increase, p=0.050), the presence of end-stage renal disease (HR=3.59, p <0.001), and the presence of liver cirrhosis (HR=1.93, p=0.013). During follow-up, 626 patients were implanted with a new ICD. In addition to being admitted with VA, a lower LVEF and a history of coronary artery disease or heart failure were the main predictors of ICD therapy in this population. In conclusion, in addition to more severe cardiomyopathy and the presence of an implanted ICD, metabolic derangements on initial contact are independent predictors of hospital admissions for VA in patients with cardiomyopathy. Noncardiac co-morbidities play an important role in stratifying patients with cardiomyopathy for their risk of VA or cardiac arrest.

Association of Physical Activity With Primary Cardiac Arrest Risk in the General Population: A Nationwide Cohort Study of the Dose-Response Relationship

ObjectiveTo quantify the dose-response relationship between moderate to vigorous physical activity and primary cardiac arrest (PCA). Patients and MethodsThere were 504,840 participants older than 18 years who underwent the Korean National Health Screening Program, including a self-administered questionnaire for physical activity from January 1, 2009, through December 31, 2014. Physical activity levels were converted into metabolic equivalent tasks (METs) per week and categorized to correspond with multiples of public health recommendations. We evaluated the quantitative and categorical dose-response relationship between physical activity and PCA. ResultsA curvilinear dose-response relationship between physical activity and PCA was observed; the benefits started at two-thirds (5 MET-hour/week) of the United States and World Health Organization guidelines–recommended minimum (7.5 MET-hour/week) and continued to 5 times (40 MET-hour/week) the recommended minimum (P nonlinearity <.001). The largest benefit was noted at a level of 2 to 3 times the recommended minimum (hazard ratio, 0.6; 95% CI, 0.4 to 0.8). In addition, there was no evidence of an increased PCA risk at a level more than 5 times the recommended minimum (hazard ratio, 0.7; 95% CI, 0.5 to 1.1). These associations were consistent regardless of age, sex, body mass index, comorbid conditions, and estimated 10-year risk for cardiovascular disease. ConclusionThe beneficial effect of physical activity on PCA started at two-thirds of the recommended minimum and continued to 5 times the recommended minimum. No excess risk for PCA was present among individuals with activity levels more than 5 times the recommended minimum regardless of cardiovascular disease or lifestyle risk factor presence.

Is Colchicine a New Game-Changer in Patients With Acute Coronary Syndrome?

Colchicine, an anti-inflammatory drug, was declared as a potently cheap and effective drug in treating atherosclerosis. This report is a detailed understanding and an in-depth interpretation of the colchicine cardiovascular outcomes trial (COLCOT) that has taken place in recent years. It is a secondary quantitative study that has reviewed studies discussing the role of colchicine in myocardial infarction, inflammation, ST-elevation myocardial infarction, and in general, acute coronary syndrome (ACS). Different trials statistically proved colchicine's role in ACS by lowering the levels of high c-reactive protein, decreasing low attenuation plaque volume, and stabilizing plaque. Hence, in other words, it has been revealed that this drug has potential in the management of ACS. Colchicine reported promising results in reducing the risk of recurrent myocardial infarction, stroke, and sudden cardiac arrest, playing a massive role in lowering inflammation and the mortality caused by cardiovascular diseases.

Accidental hypothermia: direct evidence for consciousness as a marker of cardiac arrest risk in the acute assessment of cold patients

BackgroundRapid stratification of the risk of cardiac arrest is essential in the assessment of patients with isolated accidental hypothermia. Traditional methods based on measurement of core temperature are unreliable in the field. Behavioural observations have been used as predictors of core temperature and thus indirect predictors of cardiac arrest. This study aims to quantify the direct relationship between observed conscious level and cardiac arrest.MethodsRetrospective case report analysis identified 114 cases of isolated accidental hypothermia meeting inclusion criteria. Level of consciousness in the acute assessment and management phase was classified using the AVPU system with an additional category of “Alert with confusion”; statistical analysis then related level of consciousness to incidence of cardiac arrest.ResultsAll patients who subsequently suffered cardiac arrest showed some impairment of consciousness (p < < .0001), and the risk of arrest increased directly with the level of impairment; none of the 33 fully alert patients arrested. In the lowest impairment category, Alert confused, a quarter of the 12 patients went on to arrest, while in the highest Unresponsive category, two thirds of the 43 patients arrested. Where core temperature was available (62 cases), prediction of arrest by consciousness level was at least as good as prediction from core temperature.ConclusionsThis study provides retrospective analytical evidence that consciousness level is a valid predictor of cardiac arrest risk in isolated accidental hypothermia; the importance of including confusion as a criterion is a new finding. This study suggests the use of consciousness alone may be at least as good as core temperature in cardiac arrest risk prediction. These results are likely to be of particular relevance to the management of accidental hypothermia in the pre-hospital and mass casualty environment, allowing for rapid and accurate triage of hypothermic patients.

Efficacy and Safety of Veno-Arterial Extracorporeal Membrane Oxygenation in the Treatment of High-Risk Pulmonary Embolism: A Retrospective Cohort Study.

ObjectivesVeno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly used to treat high-risk pulmonary embolism (PE). However, its efficacy and safety remain uncertain. This retrospective cohort study aimed to determine whether ECMO could improve the clinical outcomes of patients with high-risk PE.MethodsForty patients with high-risk PE, who were admitted to Kaohsiung Chang Gung Memorial Hospital between January 2012 and December 2019, were included in this study. Demographic data and clinical outcomes were compared between patients treated without ECMO (non-ECMO group) and those treated with ECMO (ECMO group). Appropriate statistical tools were used to compare variables between groups and the survival was analyzed using the Kaplan–Meier method.ResultsThe overall in-hospital mortality rate was 55%, in which 65% (26/40) of patients presented with cardiac arrest with a mortality rate of 77%, which was higher than that of patients without cardiac arrest (14%). There was no significant difference in major complications and in-hospital mortality between the non-ECMO and ECMO groups. However, in subgroup analysis, compared with patients treated without ECMO, earlier ECMO treatment was associated with a reduced risk of cardiac arrest (P = 0.023) and lower in-hospital mortality (P = 0.036). A log-rank test showed a significantly higher cumulative overall survival in the earlier ECMO treatment group (P = 0.033).ConclusionsIn this retrospective cohort study, earlier ECMO treatment was associated with lower in-hospital mortality among unstable patients without cardiac arrest. Our findings suggest that ECMO can be considered as an initial treatment option for patients with high-risk PE in higher-volume hospitals.