Cardiac Arrest Research Articles

Association of antipsychotic formulations with sudden cardiac death in patients with schizophrenia: A nationwide population-based case–control study

The aim of this study was to clarify the association between various antipsychotic formulations—oral-daily antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs), and their combination—and the risk of sudden cardiac death (SCD). We conducted a nationwide population-based case–control study using data from 2011 to 2020 from the National Health Insurance Research Database and multiple-cause-of-death data from Taiwan. The study included patients with a new diagnosis of schizophrenia who were followed for SCD occurrence until 2020. Cases and controls were frequency-matched at a 1:4 ratio by age, sex, and year of new schizophrenia diagnosis. Compared with the use of OAP monotherapy, the use of LAI and OAP combination (OR=1.91) and LAI monotherapy (OR=1.45) were associated with an increased risk of SCD. Additionally, cardiovascular comorbidities (adjusted OR=11.15) were identified as a significant risk factor for SCD. This study revealed the following hierarchy of SCD risk associated with antipsychotic formulations (listed from lowest to highest risk): nonuse of antipsychotics, OAP monotherapy, LAI monotherapy, and their combination. These findings underscore the importance of assessing cardiovascular disease history before LAIs are prescribed to patients with schizophrenia and indicate that physicians should avoid prescribing combined antipsychotics when using LAIs.

Bystanders’ willingness to assist using automated external defibrillators during cardiac arrest

The “bystander effect,” in which the presence of others inhibits rescue actions, has not been specifically examined in the context of cardiac arrest; understanding this effect in relation to rescue with automated external defibrillators (AEDs) is important. This study aims to identify the presence of others as a factor inhibiting rescue actions using an AED, from a social psychology perspective. We collected data through a web-based questionnaire involving registered residents in all 47 prefectures of Japan. The participants were presented with hypothetical scenarios of witnessing cardiac arrest events at train stations, under sparse or crowded conditions, and with or without the presence of competent parties (e.g., station staff or security guards). Their willingness to intervene was assessed across three levels of rescue behavior: (1) running and calling for help, (2) retrieving an AED, and (3) using an AED. This study found evidence of the bystander effect, indicating that the presence of competent others reduced behavioral interventions by bystanders during out-of-hospital cardiac arrest (OHCA) events. Moreover, the perceived presence of competent parties at the scene of a cardiac arrest reduced bystanders’ willingness to initiate rescue under certain circumstances. While many bystanders were willing to initiate rescue efforts in response to calls for help, they resisted rescues involving an AED. This study observes that a bystander effect occurs among bystanders witnessing OHCA, explores the inhibiting effects of identifying competent parties on the initiation of rescue efforts, and suggests that there are significant invisible barriers to using AEDs in rescuing patients with OHCA.

Neuroprotective effect of autologous mitochondrial transplantation against global ischemia/reperfusion injury in a rat model of cardiac arrest

BackgroundMitochondria have emerged as a promising target for ischemic disease. A previous study reported the application of mitochondrial transplantation in focal cerebral ischemia/reperfusion injury, but it is unclear whether exogenous mitochondrial transplantation could be a therapeutic strategy for global ischemia/reperfusion injury induced by cardiac arrest. MethodsWe hypothesized that transplantation of autologous mitochondria would rescue hippocampal cells and alleviate neurological impairment after cardiac arrest. In this study, we employed a rat cardiac arrest-global cerebral ischemia injury model (CA-GCII) and transplanted isolated mitochondria intravenously. Behavior test was applied to assess neurological deficit. Apoptosis and mitochondria permeability transition pore opening in hippocampus was determined using immunoblotting and swelling assay, respectively. ResultsTransplanted mitochondria distributed throughout hippocampal cells and reduced oxidative stress. An improved neurological outcome was observed in rats receiving autologous mitochondria. In the hippocampus, mitophagy was enhanced while cell apoptosis was induced by ischemia/reperfusion insult was downregulated by mitochondrial transplantation. Mitochondrial permeability transition pore (MPTP) opening in surviving hippocampal cells was also suppressed. ConclusionsThese results indicated that transplantation of autologous mitochondria rescued hippocampal cells from ischemia/reperfusion injury and ameliorated neurological impairment caused by cardiac arrest.

A protocol for the ERICA-ARREST feasibility study of Emergency Resuscitative Endovascular Balloon occlusion of the Aorta in Out-of-Hospital Cardiac Arrest

BackgroundFewer than one in ten out-of-hospital cardiac arrest (OHCA) patients survive to hospital discharge in the UK. For prehospital teams to improve outcomes in patients who remain in refractory OHCA despite advanced life support (ALS); novel strategies that increase the likelihood of return of spontaneous circulation, whilst preserving cerebral circulation, should be investigated. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has been shown to improve coronary and cerebral perfusion during cardiopulmonary resuscitation. Early, prehospital initiation of REBOA may improve outcomes in patients who do not respond to standard ALS. However, there are significant clinical, technical, and logistical challenges with rapidly delivering prehospital REBOA in OHCA; and the feasibility of delivering this intervention in the UK urban–rural setting has not been evaluated. MethodsThe Emergency Resuscitative Endovascular Balloon Occlusion of the Aorta in Out-of-Hospital Cardiac Arrest (ERICA-ARREST) study is a prospective, single-arm, interventional feasibility study. The trial will enrol 20 adult patients with non-traumatic OHCA. The primary objective is to assess the feasibility of performing Zone I (supra-coeliac) aortic occlusion in patients who remain in OHCA despite standard ALS in the UK prehospital setting. The trial’s secondary objectives are to describe the hemodynamic and physiological responses to aortic occlusion; to report key time intervals; and to document adverse events when performing REBOA in this context. DiscussionUsing compressed geography, and targeted dispatch, alongside a well-established femoral arterial access programme, the ERICA-ARREST study will assess the feasibility of deploying REBOA in OHCA in a mixed UK urban and rural setting.Trial registration.ClinicalTrials.gov (NCT06071910), registration date October 10, 2023, https://classic.clinicaltrials.gov/ct2/show/NCT06071910

Crisis checklist for critical event debriefings: Findings from a mixed-methods study

BackgroundPerioperative critical events (e.g., anaphylaxis, cardiac arrest) are common life-threatening emergencies across health systems but may be infrequent at the level of the individual clinician. Proximal debriefing shortly after such events has been promoted in the medical literature and via simulation, however the gap between principle and practice is poorly understood. We sought to study the patterns and components of these debriefs based on real-life events. MethodsIn this observational mixed-methods study, anesthesia providers in perioperative care areas and intensive care units from an academic medical center who recently experienced a perioperative critical event were queried regarding patterns of critical event debriefing and invited to participate in a semi-structured interview. We measured the types and location of critical events, rate of debriefing, and supporting themes surrounding the event. ResultsOver a six-month period, 81 critical events were queried, of which 28 (35 %) were debriefed. Common events included significant/prolonged hypotension and/or hypoxemia (33 %), cardiac arrest (27 %), and massive hemorrhage (21 %). Common event locations included operating room (70 %), nonoperating room anesthesia (10 %), and intensive care unit (7 %). Of the events queried, 51 events had a semi-structured interview. The themes for an ideal debriefing aligned with the themes of performing a Welfare check, assessing Acute corrections, soliciting Team reactions, allowing for medical Education, and providing supportive Resources. ConclusionOne-third of perioperative critical events were proximally debriefed. Themes from involved anesthesiology personnel revealed desirable components of a practical and brief real-time proximal debriefing. A checklist encompassing a review of the literature, multidisciplinary expertise, and lessons from this mixed-methods work has the potential to improve the quantity and quality of debriefing that is often absent in the aftermath of a perioperative critical event.

Hypothermia After Cardiac Arrest in Large Animals (HACA-LA): Study protocol of a randomized controlled experimental trial

BackgroundInduced hypothermia post-cardiac arrest is neuroprotective in animal experiments, but few high-quality studies have been performed in larger animals with human-like brains. The neuroprotective effect of postischemic hypothermia has recently been questioned in human trials. Our aim is to investigate whether hypothermia post-cardiac arrest confers a benefit compared to normothermia in large adult animals. Our hypothesis is that induced hypothermia post cardiac arrest is neuroprotective and that the effect diminishes when delayed two hours. MethodsAdult female pigs were anesthetized, mechanically ventilated and kept at baseline parameters including normothermia (38 °C). All animals were subjected to ten minutes of cardiac arrest (no-flow) by induced ventricular fibrillation, followed by four minutes of cardiopulmonary resuscitation with mechanical compressions, prior to the first countershock. Animals with sustained return of spontaneous circulation (systolic blood pressure >60 mmHg for ten minutes) within fifteen minutes from start of life support were included and randomized to three groups; immediate or delayed (2 h) intravenous cooling, both targeting 33 °C, or intravenously controlled normothermia (38 °C). Temperature control was applied for thirty hours including cooling time, temperature at target and controlled rewarming (0.5 °C/h). Animals were extubated and kept alive for seven days. The primary outcome measure is histological brain injury on day seven. Secondary outcomes include neurological and neurocognitive recovery, and the trajectory of biomarkers of brain injury. ConclusionHigh-quality animal experiments in clinically relevant large animal models are necessary to close the gap of knowledge regarding neuroprotective effects of induced hypothermia after cardiac arrest.Trial registration:Preclinicaltrials.eu (PCTE0000272), published 2021-11-03.

Walking time to nearest public automated external defibrillator for out-of-hospital cardiac arrest in a major U.S. city

BackgroundHow frequently out-of-hospital cardiac arrest (OHCA) occurs within a reasonable walking distance to the nearest public automated external defibrillator (AED) has not been well studied. MethodsAs Kansas City, Missouri has a comprehensive city-wide public AED registry, we identified adults with an OHCA in Kansas City during 2019–2022 in the Cardiac Arrest Registry to Enhance Survival. Using AED location data from the registry, we computed walking times between OHCAs and the nearest registered AED using the Haversine formula, a mapping algorithm to calculate walking distance in miles from one location to another. Results were stratified by OHCA location (home vs. public) and by whether the patient received bystander cardiopulmonary resuscitation (CPR). ResultsOf 1,522 OHCAs, 1,291 (84.8%) occurred at home and 231 (15.2%) in public. Among at-home OHCAs, 634 (49.1%) received bystander CPR and no patients had an AED applied even as 297 (23.0%) were within a 4-minute walk to the closest public AED. Among OHCAs in public, 108 (46.8%) were within a 4-minute walk to the closest public AED. For public OHCAs within a 4-minute walk, bystanders applied an AED in 13 (12.0%) of these cases and in 24.5% (13/53) of those who received bystander CPR. ConclusionIn one U.S. city with a publicly available AED registry, there were no instances in which a bystander accessed a public AED for an OHCA at home. For OHCAs in public, nearly half occurred within a 4-minute walk to the closest AED but bystander use of an AED was low.

The impact of injuries at the time of cardiac arrest on the prognosis of extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest patients

AimExtracorporeal cardiopulmonary resuscitation (ECPR) is an effective treatment for out-of-hospital cardiac arrest and refractory ventricular fibrillation. Despite the success of this intervention, trauma is a potential complication that may adversely impact patient outcomes. This study assessed the incidence and impact of trauma in patients who underwent ECPR. We hypothesized that all trauma incurred until the conclusion of ECPR would have a significant negative effect on survival and neurological outcomes. MethodsThis retrospective observational study examined all ECPR patients admitted to a tertiary emergency medical center between January 2015 and December 2021. All patients underwent pan-scan computed tomography (CT) before admission to the intensive care unit. The head and body trauma were assessed from CT images taken after ECPR. Trauma was defined as all trauma affecting post-ECPR management. In other words, all trauma caused by collapse, trauma caused by resuscitative actions such as chest compressions, and vascular injuries associated with ECPR were included. Univariate analysis of neurological prognosis and 30-day survival due to complicated trauma was performed. ResultsA total of 189 patients (mean age 55.2 ± 13.4 years; 85.2% male) were included in this study. Four patients (2.1%) had head trauma, and 31 patients (16.4%) had torso trauma. All patients with head trauma died during extracorporeal membrane oxygenation management. In patients with torso trauma, 30-day survival was not significantly different compared with that in those without trauma (31.5% vs. 41.9%, P = 0.60); good neurological outcomes were almost the same (26.0% vs. 25.8%, P = 1.00). Approximately half of the patients with torso trauma (48%) underwent transarterial embolization. ConclusionPatients treated with ECPR can suffer a variety of traumatic injuries from the time of collapse to the establishment of ECMO. Head trauma may be lethal and warrants caution. With appropriate treatment, patients with torso trauma may have an equivalent prognosis to those without traumatic complications.

Extracorporeal cardiopulmonary resuscitation for pediatric out-of-hospital cardiac arrest: A review of the Extracorporeal Life Support Organization Registry

AimsCurrent data are insufficient for the leading resuscitation societies to advise on the use of extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to explore the current utilization of ECPR for pediatric OHCA and characterize the patient demographics, arrest features, and metabolic parameters associated with survival. MethodsRetrospective review of the Extracorporeal Life Support Organization Registry database from January 2020 to May 2023, including children 28 days to 18 years old who received ECPR for OHCA. The primary outcome was survival to hospital discharge. ResultsEighty patients met inclusion criteria. Median age was 8.8 years [2.0-15.8] and 53.8% of patients were male. OHCA was witnessed for 65.0% of patients and 46.3% received bystander cardiopulmonary resuscitation (CPR). Initial rhythm was shockable in 26.3% of patients and total CPR duration was 78 minutes [52-106]. Signs of life were noted for 31.3% of patients and a cardiac etiology precipitating event was present in 45.0%. Survival to discharge was 29.9%. Initial shockable rhythm was associated with increased odds of survival (unadjusted OR 4.7 [1.5-14.5]; p=0.006), as were signs of life prior to ECMO (unadjusted OR 7.8 [2.6-23.4]; p<0.001). Lactate levels early on-ECMO (unadjusted OR 0.89 [0.79-0.99]; p=0.02) and at 24 hours on-ECMO (unadjusted OR 0.62 [0.42-0.91]; p<0.001) were associated with decreased odds of survival. ConclusionsThese preliminary data suggest that while overall survival is poor, a carefully selected pediatric OHCA patient may benefit from ECPR. Further studies are needed to understand long-term neurologic outcomes.

EPOS-OHCA: Early Predictors of Outcome and Survival after non-traumatic Out-of-Hospital Cardiac Arrest

BackgroundPost-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA) poses significant challenges due to its complex pathomechanisms involving inflammation, ischemia, and reperfusion injury. The identification of early available prognostic indicators is essential for optimizing therapeutic decisions and improving patient outcomes. MethodsIn this retrospective single-center study, we analyzed real-world data from 463 OHCA patients with either prehospital or in-hospital return of spontaneous circulation (ROSC), treated at the Cardiac Arrest Center of the University Hospital of Marburg (MCAC) from January 2018 to December 2022. We evaluated demographic, prehospital, and clinical variables, including initial rhythms, resuscitation details, and early laboratory results. Statistical analyses included logistic regression to identify predictors of survival and neurological outcomes. ResultsOverall, 46.9% (n = 217) of patients survived to discharge, with 70.1% (n = 152) achieving favorable neurological status (CPC 1 or 2). Age, initial shockable rhythm, resuscitation time to return of spontaneous circulation (ROSC), and early laboratory parameters like lactate, C-reactive protein, and glomerular filtration rate were identified as independent and combined Early Predictors of Outcome and Survival (EPOS), with high significant predictive value for survival (AUC 0.86 [95% CI 0.82–0.89]) and favorable neurological outcome (AUC 0.84 [95% CI 0.80–0.88]). ConclusionIntegration of EPOS into clinical procedures may significantly improve clinical decision making and thus patient prognosis in the early time-crucial period after OHCA. However, further validation in other patient cohorts is needed.

Clinical outcomes of challenging out-of-hospital hypothermia management: A retrospective assessment of DOKEI protocol

BackgroundAccidental hypothermia (AH) is a major cause of death in mountainous areas globally, and the second highest of mountaineering deaths in Japan, accounting for 37 % in Hokkaido. Managing AH is a significant challenge, particularly when adverse weather complicates the application of recommended rewarming and rapid transfer. To address this, the Hokkaido Police Organization (DOKEI) AH protocol was applied in Hokkaido's remote areas from 2011 to 2022, integrating high-temperature active external rewarming (HT-AER) with on-site sustained treatment. MethodsThis study retrospectively analyzed the rescue reports and hospital records of hypothermia patients treated postprotocol, excluding patients with cold exposure, undetectable vital signs at rescue, and inadequate documentation. Protocol adherence and outcomes—hypothermia stage, cardiocirculatory collapse, survival, and neurological status—were assessed. ResultsAmong the 60 protocol-treated patients (19–74 years, 85 % male), 14 had stage 2 hypothermia, and 3 had stage 3 hypothermia. HT-AER was applied in 96.7 % of the patients. A total of 98.3 % of patients improved before handover without cardiac arrest (CA) or extracorporeal life support (ECLS). Comparatively, ten preprotocol patients (18–60 years, 70 % male) had two CAs, one fatal and six with no improvement. ConclusionThe DOKEI AH protocol demonstrates feasibility in managing stages 1–3 hypothermia, enhancing survival and neurological recovery, and can offer a vital option in challenging AH rescue scenarios.

Low foetal heart rate, a potentially ominous finding: case report

Abstract Background Congenital long QT syndrome (LQTS) type 1 is characterized by abnormally prolonged ventricular repolarization caused by inherited defects in cardiac potassium channels. Patients are predisposed to ventricular arrhythmias and even sudden cardiac death. In some cases, foetal sinus bradycardia is the only sign, making prenatal diagnosis challenging. Physicians should be aware of this subtle presentation of LQTS. Early diagnosis and proactive treatment are crucial for preventing unexpected cardiac events. Case summary A healthy and asymptomatic 25-year-old pregnant woman was referred to our institute for cardiac evaluation after persistent foetal sinus bradycardia was detected during repeated ultrasounds, despite the absence of any foetal morphological or functional cardiac anomalies. After a thorough assessment, the mother was diagnosed with LQTS type 1, as confirmed by molecular genetic testing. Appropriate management, including maternal medication and increased surveillance, was initiated. The infant was delivered safely, and his electrocardiogram revealed a significantly prolonged QTc interval. Genetic testing confirmed the maternally inherited variant in KCNQ1 gene, and beta-blocker therapy was started. No arrhythmic events were noted. Discussion Detection and careful stratification of foetal heart rate (FHR) is crucial in every pregnancy. Foetal bradycardia can be caused by both maternal and foetal factors. Persistent low FHR should raise a high suspicion for LQTS. The condition may also present with atrioventricular blocks, torsades de pointes, or sudden intrauterine foetal demise. Accurate and early diagnosis of LQTS is essential for implementing appropriate management strategies, which include vigilant monitoring, effective medical treatment, careful planning of delivery, and post-natal care.

Frequency and Pattern of Anomalous Origin of Coronary Artery in Bangladeshi Population: Coronary Angiogram Based Single Center Study

Background: Anomalous origin of coronary artery (AOCA) has been traditionally described by coronary angiography or autopsy. However the actual prevalence of such abnormalities is unknown in general Bangladeshi population. Beside conventional coronary angiogram(CAG), CT CAG and Multi-detector computed tomography (MDCT) offers higher possibility to visualize AOCA non-invasively. The purpose of this study was to report the prevalence AOCA in Bangladeshi population by using conventional CAG. Methodology: This was a single center, cross sectional, observational study, done in department of Cardiology, BSMMU over 1 year period. Sample size was 1167. Samples were taken following inclusion and exclusion criteria. Descriptive statistical analysis was done by using SPSS v29.0 Results: 1.3% population had AOCA. Commonest (0.6%) was ‘absent Left main (LM) with separate origin of Left Anterior Descending (LAD) and Left Circumflex (LCX) artery. Second commonest (0.45%) was ‘Right Coronary Artery (RCA) arising from left sinus’. 0.17% had RCA highup origin, and 0.08% had RCA origin from posterior sinus. Discussion: Among AOCA, RCA origin from left sinus, is potentially dangerious, due to high risk of sudden cardiac death (SCD) and surgical complications. Other varities of AOCA are mostly benign, but it may cause difficulties in cannulation during coronary angiography and coronary artery bypass surgery. Conclusion: Although coronary artery anomalies are rare, they may cause difficulties during coronary interventions or cardiac surgery and may occasionally result in sudden cardiac death. So, optimum precaution to findout the AOCA is needed during conventional CAG, and if suspicion, CT CAG and MDCT should also be used. (Bangladesh Heart Journal 2024; 39(2): 117-120

Association of Fragmented QRS Complex with Short Term Outcome in Patients with Acute ST-Elevation Myocardial Infarction

Background: Acute ST-elevated myocardial infarction is a life-threatening condition. Presence of fragmented QRS (fQRS) after acute STEMI is associated with alteration of myocardial activation due to myocardial scar and myocardial fibrosis. Previous studies have suggested that fQRS in acute STEMI is associated with increased mortality, morbidity, sudden cardiac death and recurrent adverse cardiovascular events. The study was designed to assess the association of fQRS complex with short-term outcome (in hospital and 30 days follow up) in patients with acute ST elevation myocardial infarction. Methods: This prospective cohort study was conducted in the Department of Cardiology, Dhaka Medical College Hospital among the STEMI patients who were thrombolysed. All patients underwent serial ECG at admission, within first 12 hours, at 24 hours and at 48 hours for detecting the presence of fQRS complex. Patients showing fQRS involving infarct territory within 48 h of admission were included in the “fQRS group” and those who did not develop fQRS within 48 h of admission were included in the “without fQRS” group. 114 patients had fQRS complex and 104 patients were without fQRS in their ECG. In-hospital outcomes such as: death, heart failure, significant arrhythmias (VT, VF AF, SVT, 20 AV block, CHB), cardiogenic shock were recorded. Among the study patients, sixteen patients were lost to follow up in 30 days of index hospitalization. Finally, 202 patients were tracked for follow up regarding death or re hospitalization information by personal contact or over telephone. Statistical analysis was performed using the statistical package for social science (SPSS) 21.0 software for windows. Results: Appearance of fQRS complex occurred at admission, within first 12 hours, 24 hours and 48 hours in 53.5%, 23.7%, 14.9% and 7.9% cases respectively. During index hospitalization, development of cardiogenic shock (27.19% vs 11.54%), heart failure (23.68% vs 9.62%) and significant arrhythmias were significantly higher in fQRS group (42.10% vs 11.53%, p&lt;0.05). Although mean duration of hospitalization was similar in both groups (p&gt;0.05), but in-hospital mortality was higher in fQRS group (11.40% vs 3.85%, p&lt;0.05). Rate of re-hospitalization was significantly higher in patients with fQRS complex (21.69% vs 7.29% p&lt;0.05). Overall mortality within 30 days of index hospitalization follow-up also differs significantly in presence of fQRS complex (19.81% vs 5.2%; p =0.006). Conclusion: Presence of fQRS complex is associated with adverse short-term outcome in patients with acute ST elevation myocardial infarction. Hence, these patients need more aggressive and early invasive treatment to reduce morbidity and mortality. Bangladesh Heart Journal 2024; 39(2); 93-101

Relationship Between Vitamin D Level and Index of CardioElectrophysiological Balance in Children.

Vitamin D deficiency has been found to be associated with various cardiovascular disorders, including hypertension, coronary artery disease, heart failure, peripheral vascular diseases, and sudden cardiac death. In the literature, it has been reported that many electrocardiographic parameters have been developed to predict ventricular arrhythmias. In recent studies, it is noteworthy that the index of cardio-electrophysiological balance (iCEB) and correct cardioelectrophysiological balance (iCEBc), which are electrocardiographic parameters, can be used as new, easy, cheap and non-invasive parameters to predict ventricular arrhythmias. This study aimed to investigate the relationship between vitamin D deficiency and iCEB and iCEBc values in children. A total of 186 patients were included in this study. Group 1 included 114 patients with vitamin D levels below 20 ng/ml; 50 patients with vitamin D levels of 21-29 ng/ml were included in Group 2; Group 3 consisted of 36 patients with a vitamin D level above 30 ng/ml. iCEB and iCEBc values were calculated by taking 12-lead ECG from all individuals and comparing them between groups. A total of 186 children, 114 subjects in Group 1, 36 subjects in Group 2, and 36 subjects in Group 3, were included in the study. Demographic characteristics and height-weight values of the groups were similar. Significant differences were found between the groups in terms of QT, QTc, QT/QRS, and QTc/QRS levels (p: 0.003, 0.028, 0.001, and 0.001, respectively). In the correlation analysis, a negative correlation was found between QTc/QRS and vitamin D level (r=-0.320, p=<0.001) and between QT/QRS and vitamin D level (r=-0.268, p=<0.001). Moreover, vitamin D level (β=0.389, p<0.001) was determined as an independent predictor of QTc/QRS in multivariate logistic regression analysis. iCEB and iCEBc parameters increase significantly in children with low vitamin D levels. These parameters are also evaluated during the follow-up of children with vitamin D deficiency in terms of the risk of ventricular arrhythmia. iCEBc can be used as an easy, inexpensive, non-invasive, and reproducible parameter.

Survival of out-of-hospital cardiac arrest patients admitted to the hospital during the Tokyo Summer Olympic and Paralympic Games in Japan

BackgroundThe influence of the Tokyo Summer Olympic/Paralympic Games on normal emergency medical system operations in Japan had not yet been fully elucidated. In this study, we examined whether out-of-hospital cardiac arrest (OHCA) patients treated during the Tokyo Olympic/Paralympic Games had differences in outcomes. MethodsUsing the nationwide JAAM-OHCA Registry, we evaluated the outcomes of OHCA patients admitted to the hospital during the Tokyo Olympic/Paralympic Games (July 23 to Aug. 8 and Aug. 24 to Sept. 5) in 2021, compared to those during same the dates in 2020 (Term 1: July 23 to Aug. 8 and Aug. 24 to Sept. 5), those during the pre-Olympic/Paralympic term during the same weekdays in the weeks before the event (Term 2: June. 18 to July. 4 and July. 6 to July. 18), and those during the post-Olympic/Paralympic term during the same weekdays in the weeks after the event (Term 3: Sept. 10 to Sept. 26 and Sept. 28 to Oct. 10). The primary outcome was 30-day survival, and multivariable logistic analysis was performed, adjusted for age and sex. ResultsA total of 3,111 OHCA patients were included in the study period (786 in the Olympic/Paralympic group, 774 in Term 1, 747 in Term 2, and 804 in Term 3). Crude 30-day survivals were 7.4% (58/786), 9.3% (72/774), 6.8% (51/747), and 8.2% (66/804), respectively. Using the Olympic/Paralympic group as a reference, multivariable logistic analysis revealed that 30-day survivals in Term 1 (OR 1.27 95% CI 0.88–1.83p = 0.20), Term 2 (OR 0.92 95% CI 0.62–1.36p = 0.67), and Term 3 (OR 1.10 95% CI 0.76–1.59p = 0.63) did not differ significantly. ConclusionsNo significant differences in 30-day survival for OHCA patients admitted during the Tokyo Summer Olympic/Paralympic Games were identified.

Association of Metabolic Derangement and Postoperative Outcomes in Hernia Repair With Component Separation: A Propensity Score-matched Nationwide Analysis

IntroductionMetabolic syndrome (MetS) is characterized by cardiometabolic abnormalities such as hypertension, obesity, diabetes, or dyslipidemia. This study aims to evaluate the association of MetS on the postoperative outcomes of ventral, umbilical, and epigastric hernia repair using component separation. MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent ventral, umbilical, and epigastric hernia repair with component separation between 2015 and 2021. MetS status was defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m2. Propensity matching was performed to generate two balanced cohorts with and without MetS. T-tests and Fisher's Exact tests assessed group differences. Logistic regression models evaluated complications between the groups. ResultsAfter propensity score matching, 3930 patients were included in the analysis, with 1965 in each group (MetS versus non-MetS). Significant differences were observed in the severity and clinical presentation of hernias between the groups. The MetS cohort had higher rates of incarcerated hernia (39.1% versus 33.2%; P < 0.001), and recurrent ventral hernia (42.7% versus 36.5%; P < 0.001) compared to the non-MetS cohort. The MetS group demonstrated significantly increased rates of renal insufficiency (P = 0.026), unplanned intubation (P = 0.003), cardiac arrest (P = 0.005), and reoperation rates (P = 0.002) than the non-MetS cohort. Logistic regression models demonstrated higher likelihood of postoperative complications in the MetS group, including mild systemic complications (OR 1.25; 95%CI 1.030-1.518; P = 0.024), severe systemic complications (OR 1.63; 95%CI 1.248-2.120; P < 0.001), and reoperation (OR 1.47; 95%CI 1.158-1.866; P = 0.002). There were no significant differences in the rates of 30-d wound complications between groups. ConclusionsThe presence of metabolic derangement appears to be associated with adverse postoperative medical outcomes and increased reoperation rates after hernia repair with component separation. These findings highlight the importance of optimizing preoperative comorbidities as surgeons counsel patients with MetS.

EuReCa – The European Registry of Cardiac Arrest and the related studies

Out-of-hospital cardiac arrest (OHCA) is a major health issue throughout Europe. Due to limited knowledge about the epidemiology of OHCA in Europe, in 2011, the European Registry of Cardiac Arrest (EuReCa) project was established. Initially based on existing resuscitation registries in a few countries, the network expanded and in October 2014 the EuReCa ONE study was launched, bringing together 27 countries and showing that appropriate data acquisition (10,682 cases submitted) is feasible within Europe. EuReCa TWO was conducted from October to December 2017 and included 37,054 cases. EuReCa THREE data collection was carried out from September to November 2022 and data analysis is currently being conducted. EuReCa TWO and THREE studies generated more robust data, with both studies covering 3-month periods in 28 countries, respectively. While EuReCa TWO focused on the bystander, EuReCa THREE investigated the impact of time-related aspects (time from call to scene, time at scene, transport times and other) on resuscitation outcomes. EuReCa is a network supporting countries in their ambition to establishing continuously running registries as quality management tools and for scientific work.

Carbon monoxide-releasing molecule-3 exerts neuroprotection effects after cardiac arrest in mice: A randomized controlled study

BackgroundPost-cardiac arrest brain injury (PCABI) is the leading cause of death in survivors of cardiac arrest (CA). Carbon monoxide-releasing molecule (CORM-3) is a water-soluble exogenous carbon monoxide that has been shown to have neuroprotection benefits in several neurological disease models. However, the effects of CORM-3 on PCABI is still unclear. MethodsA mice model combined asystole with hemorrhage was used. Mice were anesthetized and randomized into 4 groups (n = 12/group) and underwent either 9.5 min CA followed by cardiopulmonary resuscitation (CPR) or sham surgery. CORM-3 (30 mg/kg) or vehicle (normal saline) were administered at 1 h after return of spontaneous circulation or sham surgery. Survival, neurologic deficits, alterations in the permeability of the brain-blood barrier and cerebral blood flow, changes of oxidative stress level, level of neuroinflammation and neuronal degeneration, and the activation of Nrf2/HO-1 signaling pathway were measured. ResultsIn CORM-3 treated mice that underwent CA/CPR, significantly improved survival (75.00% vs. 58.33%, P = 0.0146 (24 h) and 66.67% vs. 16.67%, P < 0.0001 (72 h)) and neurological function were observed at 24 h and 72 h after ROSC (P < 0.05 for each). Additionally, increased cerebral blood flow, expression of tight junctions, and reduced reactive oxygen species generation at 24 h after ROSC were observed (P < 0.05 for each). CORM-3 treated mice had less neuron death and alleviated neuroinflammation at 72 h after ROSC (P < 0.05 for each). Notably, the Nrf2/HO-1 signaling pathway was significantly activated in mice subjected to CA/CPR with CORM-3 treatment. ConclusionsCORM-3 could improve survival and exert neuroprotection after CA/CPR in mice. CORM-3 may be a novel and promising pharmacological therapy for PCABI.

Outcomes for Mechanically Ventilated Patients With Acute Myocardial Infarction Admitted to Medical vs Cardiac Intensive Care Units

BackgroundAcute myocardial infarction (AMI) remains a common reason for admission to the intensive care unit (ICU). However, there is limited data comparing outcomes for patients with AMI admitted to specific ICUs. ObjectivesThe purpose of this study was to assess clinical outcomes between patients with AMI requiring invasive mechanical ventilation admitted to the medical ICU (MICU) compared to cardiac (CICU). MethodsWe utilized the Vizient Clinical Data Base to identify patients with a primary diagnosis of AMI between October 2015 and December 2019 and requiring invasive mechanical ventilation. Using multivariable logistic regression, we compared clinical outcomes for patients admitted to the MICU vs CICU. ResultsWe identified 12,639 patients, 25.2% (n = 3,185) of which were admitted to a MICU and 74.8% (n = 9,454) to a CICU. Patients admitted to a CICU were more likely to present with STEMI (57.0% vs 42.8%), cardiogenic shock (46.0% vs 37.4%), and require mechanical circulatory support and vasoactive medications (all, P < 0.001). Median ventilator days were 4 days in both ICUs and not statistically different after multivariable adjustment (P = 0.81). In-hospital mortality was 42.7% compared to 41.3% for MICU vs CICU admissions, respectively (P = 0.15). After multivariable adjustment, CICU admission was associated with lower in-hospital mortality (OR: 0.85, 95% CI: 0.78-0.93, P = 0.001), which persisted when stratified by cardiogenic shock, cardiac arrest, STEMI, largest hospital size (>750 beds), and teaching hospitals (all, P < 0.05). ConclusionsAdmission to the CICU, as compared to MICU, was associated with lower in-hospital mortality for patients with AMI. These findings may support optimal triage of critically ill patients with AMI.