Sudden Circulatory Arrest Research Articles

Клинико-морфологическое обоснование использования добутамина при ожоговом шоке

Introduction. An effective way to reduce the volume of infusion (restrictive strategy) in hypovolemic shock, in particular in burn shock, is invasive hemodynamic monitoring and choosing the appropriate regimen for the use of inotropic agents, considering the data obtained. However, the use of inotropic agents in hypovolemic shock is still controversial. The most cutting issue is the choice of effective doses of inotropic agents. Aim. Justification of the need to use inotropic agents and assessment of the safety and effectiveness of dobutamine use in burn shock. Materials and methods. The pilot clinical study conducted in 2021–2022 included 9 patients aged 15–70 years who were admitted to the intensive care unit (ICU) of the Burn Center of the Novosibirsk State Regional Clinical Hospital with a total body surface area burned > 40% (II–III degree), in most cases – thermal inhalation injury, who were in the ICU for over 3 days. Intensive care of burn injury in the acute phase was performed according to conventional clinical recommendations. Myocardial samples for morphological and immunohistochemical studies were taken from 34 patients who died from burn shock (27 men and 7 women, aged from 21 to 51 years) from 2015 to 2019. The samples were taken post mortem, and with minimal atherosclerotic changes of the coronary arteries (lesions no more than 20–25%). The control group for morphological and immunohistochemical studies comprised samples which were taken from 25 individuals who died because of sudden circulatory arrest (19 men, 6 women). Results. Studies have shown a decrease in myocardial contractility in patients with burn shock. Morphological examination revealed contraction lesions of individual cardiomyocytes of varying degree, as well as foci of primary clumping of myofibrils’ cytoplasm and myocytolysis. The immunohistochemical study of myocardial sections showed a decrease in the actin expression by 2.4 times (p < 0.05) and desmin – by 2 times (p < 0.05) in comparison with the control group. The results of the clinical study showed that dobutamine at a rate of up to 5.0 μg/kg/min does not cause an arrhythmogenic effect and/or lactic acidosis. Conclusion. The data obtained on structural changes of the myocardium confirm the need for the use of inotropic agent in burn shock. Dobutamine at a rate of up to 5.0 μg/kg/min allows for a restrictive strategy of fluid resuscitation and rapid recovery from burn shock.

COVİD-19 Dönemine ait Mavi Kod Uygulama Sonuçlarının Değerlendirilmesi

Giriş ve Amaç: Mavi Kod, hastanelerde yaşanabilecek ani dolaşım ve solunum durmasında, hastanın en kısa sürede resüsite edilmesini sağlamaya yönelik kullanılan acil durum hastane kodudur. Mavi kod ekibi hastanede kardiyopulmoner resüsitasyon (KPR) konusunda deneyimli ve eğitimli uzman hekim ve hemşirelerden oluşan kalbi yeniden canlandırma müdahale ekibidir. 
 Gereç ve Yöntemler: Bu çalışmada Mart 2020- Eylül 2021 tarihleri arasında mavi kod çağrısı verilen hastaların verileri retrospektif olarak analiz edildi. Bu süreçte 58 olgu için mavi kod çağrısı verildi, yaş ortalaması 54.78±21.7 yıl olarak bulunmuştur. Pandemi servisleri mavi kod çağrısı verilen birimler arasında üst sıralarda yer almaktadır. Bulgular: Mavi kodlarda uygulanan KPR sonucu 7 hasta (%53) eksitus kabul edilirken, 6 hastada (%47) ritm sağlandıktan sonra yoğun bakım ünitesine nakli sağlanmıştır. 
 Sonuç: Sonuç olarak; en kısa sürede ve eğitimli ve tecrübeli bir ekiple uygulanan KPR, insan hayatına gösterilen önem ve saygı, yasal sorumluluk ve kaliteli sağlık hizmeti sunumu açısından isabetli ve vazgeçilmez bir standarttır.

First Russian experience in liver and kidney transplantation from donors with out-of-hospital cardiac arrest: 3 years’ results

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Problems of medical evacuation and in-patient treatment of patients and injured with sudden arrest of circulation occurred outside medical institution

Relevance. According to the data of the international register, the use of extracorporeal membrane oxygenation (ECMO) with mechanical circulatory support in the cardiopulmonary-cerebral resuscitation complex can save up to 30% among patients with sudden cardiac death.Intention. Analyze the main logistical and organizational problems of patient treatment identified over the two years of operation of the Center for the Treatment of Sudden Cardiac Death.Methods. A retrospective analysis of patients admitted in the period from October 2017 to January 2020 in a state of clinical death to the Center for the Treatment of Sudden Cardiac Death of a university clinic was carried out.Results and Discussion. In the course of the analysis, the criteria for connecting ECMO- cardiopulmonary resuscitation were developed. In most cases, the primary cause of death was cardiogenic factors (AMI, PE, fatal arrhythmias, etc.), while AMI was confirmed in 33 episodes. During the entire period of the Center’s operation, not a single patient has been admitted that fully meets the criteria for ECMO- cardiopulmonary resuscitation. However, the technology has been used as therapy for “despair” on six occasions. The main problem at present is long-term and multistage care outside the medical organization. The possibility of using ECMO posthumously was studied in order to preserve the organs of the corpse for subsequent transplantation. During two years of work, 11 effective donors were conditioned, thanks to which 22 kidney transplants and 2 liver transplants were successfully performed at the University.Conclusion. The experience gained has shown the need to revise the algorithms for providing care to patients with sudden circulatory arrest outside the medical organization, in order to expedite transportation to the ECMO center. In the case of ineffectiveness of extended resuscitation in the clinic, it is possible to consider the use of post mortem technology for conditioning a potential posthumous donor for the preservation of organs for the purpose of their subsequent transplantation.

Eosinophilic Granulomatosis with Polyangiitis with Pulmonary and Cardiac Involvement

A 62-year-old patient with bronchial asthma and chronic rhinosinusitis underwent inguinal hernia surgery. After the operation, sudden circulatory arrest occurred, requiring cardiopulmonary resuscitation. Coronary angiography revealed a 99 % proximal stenosis of right coronary artery (RCA) with unsuspicious and smooth coronary vessel walls. In the further course, several similar events occurred, but without pathological findings in the coronary angiography. Initially, echocardiography showed slightly reduced left ventricular ejection fraction of 45 %. Chest radiography revealed bilateral pulmonary infiltrates, and white blood cell count showed severe eosinophilia (37 %). Serological antibody testing including ANA, ENA and c-/p-ANCA was negative. Myeloproliferative pathologies were excluded by bone marrow puncture. The patient suffered from emerging dyspnea, weakness, and ongoing weight loss. A methylprednisolone pulse of 250 mg/d for 3 days remained without significant effect, so that the patient was eventually referred to our university hospital due to ongoing clinical deterioration. On admission, the patient suffered from weakness, progressive muscular atrophy, and dyspnea on exertion. Physical examination revealed a right-sided peroneal paralysis. Bronchial lavage detected severe eosinophil alveolitis (37 %), and laboratory findings showed elevated cardiac enzymes and NT-proBNP (Troponin-T > 700 ng/l, NT-proBNP > 10.000 ng/l). Echocardiography revealed a dramatic deterioration of cardiac function (LVEF 16 %). Interdisciplinary discussion between pulmonologists and cardiologists lead to the diagnosis of ANCA-negative eosinophilic granulomatosis with polyangiitis (EGPA) with pulmonary and cardiac involvement. Initiation of immunosuppressive therapy with methylprednisolone 1000 mg/d for 3 days followed by cyclophosphamide therapy (6 pulses, administered every 4 weeks) led to substantial symptomatic improvement, complete regression of pulmonary infiltrates and marked recovery of cardiac function (LVEF 47 %). CONCLUSION: Serological detection of elevated ANCAs is not necessary for diagnosis of EGPA. Only 30 - 70 % of patients are positive for these, particularly if neurological and/or renal rather than cardiac and/or pulmonary involvement is present. This may be a pitfall in establishing the correct diagnosis. Induction therapy with cyclophosphamide is the preferred treatment for steroid-refractory EGPA with life-threatening organ involvement.

Predictors of a complicated course after surgical repair of tetralogy of Fallot.

In this study, we aimed to evaluate the patient and surgical factors affecting prolonged hospital stay and major adverse events after surgical repair of tetralogy of Fallot and to identify the predictors of a complicated course after surgical repair. A total of 170 consecutive patients (96 males, 74 females; median age 12 months; range, 1 to 192 months) who underwent surgical repair of tetralogy of Fallot between January 2015 and April 2018 were retrospectively reviewed. A mechanical ventilation duration of >24 h, an intensive care unit stay of >3 days, and a hospital stay of >7 days were considered as prolonged. Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, renal failure, diaphragmatic paralysis, neurological deficit, sudden circulatory arrest, need for extracorporeal membrane oxygenation, and death were considered as major adverse events. The median time to hospital discharge was 8.0 (range, 5.0 to 40.0) days. Higher preoperative hematocrit levels prolonged the length of hospital stay (odds ratio: 1.12, 95% confidence interval 1.1-1.2, p<0.001). A total of 28 major adverse events were observed in 17 patients (10%). Lower pulmonary artery annulus Z-score (odds ratio: 0.5, 95% confidence interval 0.3-0.9, p=0.01) and residual ventricular septal defects (odds ratio: 54.6, 95% confidence interval 1.6-1,874.2, p=0.03) were found to increase mortality. Residual ventricular septal defect was also a risk factor for major adverse events (odds ratio: 12.4, 95% confidence interval 1.5-99.9, p=0.02). Preoperative and operative factors such as high preoperative hematocrit, low preoperative oxygen saturation, low pulmonary annulus Z-score, Down syndrome, residual ventricular septal defects, and the use transannular patch were found to be associated with prolonged length of hospital stay, prolonged mechanical ventilation, prolonged intensive care unit stay, and increased development of major adverse events.

Controlled automated reperfusion of the whole body after cardiac arrest.

Sudden circulatory arrest (CA) requiring cardiopulmonary resuscitation (CPR) has for decades been associated with high mortality and frequent neurological sequelae in the rarer survivors. The high mortality and morbidity are potentially related to a severe and global ischemia/reperfusion injury (IRI) of the whole body, especially the brain. Consequently, strategies to counteract this severe IRI may improve survival and neurological recovery of affected patients. Based on the target to limit IRI in single organs, suitable parameters and methods were composed to form a global treatment concept, the CARL method (controlled automated reperfusion of the whole body). The concept centers on extracorporeal circulation, enhanced with readily available online monitoring. It allows for targeted adaption of different parameters (i.e., blood pressure and flow, temperature, oxygen content, electrolytes) during the reperfusion process, in the sense of a controlled reperfusion. Parameters and elements of the CARL method were extensively tested in a chronic animal model. An appropriate medical device, the system configuration "CIRD 1.0" (Controlled Integrated Resuscitation Device) is approved to be applied to patients. A set of parameters that support a limitation of a global IRI have been identified in over 250 animal experiments. Their specific targets and surveillance using adequate monitoring features are described. Using the CIRD in a single center, 14 patients with witnessed, but extremely prolonged CPR (51-120 minutes) have been treated with CARL. The outcome of these patients was favorable, with 7 of 14 patients regaining full consciousness and 6 of 7 allocated to Cerebral Performance Class (CPC) "1". CA followed by CPR is associated with a very high mortality and frequent neurological sequelae. Limiting the occurring severe and global IRI may be a key to an improved survival and neurological recovery. Therefore, the therapeutic approach of CARL, which stands for a personalized, comprehensive therapy based on a readily available set of monitoring data and diagnostic findings, has been developed. First experience in patients indicates beneficial effects that call for further studies in the field of CARL.

Risk Factors for Major Adverse Events after Surgical Closure of Ventricular Septal Defect in Patients Less than 1 Year of Age: A Single-Center Retrospective.

ObjectiveTo reveal the risk factors that can lead to a complicated course and an increased morbidity in patients < 1 year old after surgical ventricular septal defect (VSD) closure.MethodsWe reviewed a consecutive series of patients who were admitted to our institution for surgical VSD closure who were under one year of age, between 2015 and 2018. Mechanical ventilation (MV) time > 24 hours, intensive care unit (ICU) stay longer than three days, and hospital stay longer than seven days were defined as “prolonged”. Unplanned reoperation, complete heart block requiring a permanent pacemaker implantation, sudden circulatory arrest, and death were considered as significant major adverse events (MAE).ResultsVSD closure was performed in 185 patients. The median age was five (1-12) months. There was prolonged MV time in 54 (29.2%) patients. Four patients (2.2%) required permanent pacemaker implantation. Hemodynamically significant residual VSD was observed in six (3.2%) patients. Extracorporeal membrane oxygenation-cardiopulmonary resuscitation was performed in one (0.5%) patient. Small age (< 4 months) (P-value<0.001) and prolonged cardiopulmonary bypass time (P=0.03) were found to delay extubation and to prolong MV time. Low birth weight at the operation was associated with MAE (P=0.03).ConclusionHigher body weight during operation had a reducing effect on the MAE frequency and shortened the MV duration, ICU stay, and hospital stay. As a conclusion, for patients who are scheduled to undergo VSD closure, body weight should be taken into consideration.

Molecular Biomarkers for Prediction of Neurological Outcome after Sudden Circulatory Arrest (Review)

The purpose of this review of the 81 publications is to discuss the current national and international data on the prediction of neurological outcomes after sudden circulatory arrest (SCA) using molecular biomarkers. The review discusses the current state of the problem of neurological outcomes after a sudden circulatory arrest, the principal therapeutic measures to improve these outcomes and currently available clinical, laboratory, and instrumental methods of diagnosis and prediction of neurological outcomes after a sudden circulatory arrest.

Surgical Treatment of Native and Prosthetic Aortic Infection With Xenopericardial Tube Grafts

The study sought to report our results of surgical treatment of native and prosthetic aortic infection with xenopericardial tube grafts from the ascending aorta to beyond the bifurcation. Within a 28-month period, 20 patients were treated with a bovine self-made pericardial tube graft to replace infected vascular grafts (after conventional surgical aortic replacement or endovascular stent graft implantation) or to treat a contaminated surgical site. An integrated standardized therapeutic concept was applied in all patients, consisting of complete removal of the infected prosthetic material, extensive debridement, and orthotopic vascular reconstruction with self-made tube grafts constructed from a bovine pericardial patch. Four patients died perioperatively (20%) due to sepsis, pulmonary failure, or sudden circulatory arrest. The mean follow-up was 18 months (first quartile 2, third quartile 17 months). Interval computed tomography scans revealed 100% freedom from proven aortic reinfection, but reinfection cannot be ruled out in 4 patients who died of unknown causes during follow-up or because of ongoing sepsis. Three patients required aortic reintervention for a suture-line aneurysm, for graft occlusion, and for the development of a neoaortointestinal fistulation, respectively. Patients with infectious aortic disease present in a frail state and the initial and the late mortality is substantial. Yet, surgical treatment of native and prosthetic aortic infection with xenopericardial tube grafts shows promising short-term results with regard to durability and freedom from reinfection in any aortic segment. Further studies are needed to learn of the long-term behavior of these grafts.

Circumstances and causes of sudden circulatory arrests in the Dutch province of Limburg and the involvement of citizen rescuers.

BackgroundRecently we showed that a citizen volunteer system using text message alerts improves survival of out-of-hospital sudden circulatory arrest (OHCA). It is important to characterise the OHCA population encountered by the volunteers regarding circumstances and causes of the arrests.Methods and ResultsEligible for this study were 968 OHCAs that occurred between April 2012 and April 2014 in the Dutch province of Limburg. The distribution of causes of OHCA, patient characteristics and resuscitation settings were compared between 492 arrests wherein volunteers were notified and 476 arrests where the dispatcher decided not to do so.In case of notification, the cause of OHCA was known in 345 cases and of cardiac origin (treatable) in 83.2% (287/345). About 41% of the cardiac arrests were caused by acute or chronic coronary artery disease. OHCA occurred within the home environment in about 84%. The OHCA was witnessed in 75% of the cases. In 60.9% of the cases a witness or bystander had already started basic life support. However, in approximately 18% of the OHCAs the volunteer was the first to start basic life support before arrival of the ambulance. In about 75% of the OHCAs the ambulance arrived at 6 minutes or later after time of notification by the dispatch centre.ConclusionThe volunteer system is predominantly activated in situations for which it was developed; cases with cardiac aetiology (58%) and cases in the home environment (84%). The majority of patients encountered by the volunteers had ‘hearts too good to die’, underscoring the benefit of deploying citizen rescuers in programs to improve survival of OHCA.

Modern principles of cardiopulmonary resuscitation in pediatric practice

Quality improvement of cardiopulmonary resuscitation (CPR) is one of the most urgent problems in pediatric anesthesiology, resuscitation and intensive care. Despite the fact that in recent years the number of surviving children after cardiopulmonary resuscitation is constantly increasing, the number of young children among them, still small, which requires further improvement of provision of intensive care, especially in the pre-hospital stage. In the last two decades the protocols of cardiopulmonary resuscitation are regularly changed and supplemented every five years, which helps to improve outcomes of resuscitative measures. In October/November 2015 came the next recommendations of American Heart Association and European Resuscitation Council for basic and advanced cardiopulmonary resuscitation in children, which is reflected in this article. Using these recommendations will significantly improve the quality of the provision of intensive care to children and contribute to a more favorable neurological outcome even after a sudden circulatory arrest. This publication reflects the epidemiological evidence on the effectiveness and outcomes of cardiopulmonary resuscitation in pediatric practice, the modern principles of basic and advanced cardiopulmonary resuscitation in children are considered in detail, special attention is given to the use of drugs and defibrillation during resuscitation. Excerpts from the regulating documents governing the termination of resuscitation and ascertaining biological death are presented in this article.

Assessment of the Quality of Basic and Expanded Resuscitative Measures in a Multifield Hospital (Simulation Course)

The survival of patients after the sudden circulatory arrest (SCA) depends not only on immediate onset of resuscitative measures, but also on their quality. The purpose of the study. The purpose is to assess the compliance of basic and expanded resuscitative measures carried out by healthcare providers in hospitals with modern national and international guidelines within the frames of a stimulation course. Materials and Methods. The research was perfomed in a multifield hospital in Moscow, in 2016. It consisted of two phases. During the first phase, within the frames of a simulation course, providers' skills in the cardiopul monary resuscitation (CPR) and chest compression (CC) technique mastership were evaluated. During the second stage, their skills in expanded CPR and ability to work as a part of resuscitation teams were assessed. During the simulation, all team activities were recorded (both audio and video); CC parameters were also registered using a CC pressure control sensor (hereinafter referred to as a sensor) and audiovisual tips. The European Resuscitation Council Guidelines for Resuscitation 2015 were used as reference criteria. The analysis was performed using the ZOLL RescueNet Code Review® software. A statistical analysis was performed using the Statistica 7.0 software (MannWhitney Utest). The data were presented as a mean, median ± 25—75 percentiles (25—75 IQR), minimum and maximum values. The difference was considered significant at P<0.05. Results. Test results of most healthcare providers were unsatisfactory when the CPR was performed without sensors and audiovisual tips: the percentage of target CCs was not more than 10% in 72% of providers (n=18). When the CPR was performed with sensors and audiovisual tips regulating the CC quality, the percentage of target CCs was 65.7%. i.e. it was significantly higher than that during the CPR without the sensor and the tips (P=0.0000). While only one provider was able to perform the target CC without the sensor and the tips (4%), 12 providers were able to do it with the sensor (48%) (P=0.0000). In all resuscitation teams, there was a lack in compliance with the ECR 2015 guidelines for expanded CPR, as well as ineffective team work was revealed. Chest compressions did not comply with recommended parameters; pauses before and after defibrillator discharge were too long. In most cases, there was hyperventilation during the artificial lung ventilation. The safety principle was not followed by one of resuscitation teams during the defibrillation procedure. Conclusion. The obtained data demonstrate that healthcare providers have poor skills in basic and expanded CPR. Therefore, it is important to train and retrain healthcare providers in basic and expanded CPR within the frames of simulation training courses on a regular basis (in accordance with European Resuscitation Council Guidelines for Resuscitation 2015 and National Resuscitation Council). During training, the use of technical means of monitoring of the chest compression quality control in CPR should be warranted. It is important to arrange regular retraining in order to keep the skills uptodate, as well as regular debriefings on the CPR quality after each case of resuscitation measures in a hospital.

Enhancing Approaches to Therapeutic Hypothermia in Patients with Sudden Circulatory Arrest

Cardiac arrest is common and causes substantial morbidity and mortality. Despite advances in prevention and resuscitation, most patients remain unconscious and survival remains poor. Therapeutic hypothermia (32-34°C) has emerged as a potent neuroprotective modality following resuscitation. In early clinical trials, application of therapeutic hypothermia improved survival in patients with ventricular fibrillation (VF), which led to the recommended use of therapeutic hypothermia for patients resuscitated from VF. However, two recent clinical trials have challenged some assumptions. First, the use of paramedic-initiated rapid infusion of cold crystalloids as a mean to achieve faster cooling rates after resuscitation in patients with and without VF arrest did not improve survival. Second, once patients were admitted to the hospital, targeting their temperature to 33 versus 36°C for 36h (in addition to active hyperthermia prevention) after out-of-hospital cardiac arrest did not to change clinical outcomes, suggesting that 36°C may represent the target temperature instead of temperatures of less than 34°C.

Is the thrombus truly free‐floating? A case report

A free-floating thrombus in the left atrium is very rare in mitral stenosis. Such a thrombus can lead to sudden circulatory arrest and syncope or can cause severe cerebral or peripheral thromboembolic events. Clinical diagnosis is difficult, but left atrial thrombus should be suspected if patients with mitral stenosis and atrial fibrillation have intermittent or changing murmurs, emboli, or syncope. We describe the case of a patient with mild mitral stenosis under warfarin therapy, and a left atrial pedunculated thrombus discovered during the investigation for syncope attacks.

Effect of smoke-free legislation on the incidence of sudden circulatory arrest in the Netherlands

ObjectiveTo investigate whether smoke-free legislation in the Netherlands led to a decreased incidence of out-of-hospital sudden circulatory arrest (SCA). Smoke-free legislation was implemented in two phases: a workplace ban in...

Wczesne powikłania tracheotomii przezskórnej metodą Griggsa w materiale własnym

The aim of the work was to assess early complications of Griggs percutaneous tracheotomy in the own material. The study covered 155 patients aged 17-88, including 36 women and 119 men. The patients were treated at the Department of Anaesthesiology and Intensive Therapy between 2006-2010. They underwent Griggs percutaneous tracheostomy by a laryngologist or a trained anaesthesiologist. Each surgical procedure was conducted with the use of Portex Blue Line Ultra Percutaneous Tracheotomy Kit (Smiths Medical Co., USA), the trachea was intubated while the patient was under general anaesthesia with propofol, fentanyl and relaxation with atracurium. The studied material revealed Griggs percutaneous tracheotomy complications in 26 patients (16.8%), in which 11 patients (7.1%) presented complications within the perioperative period while 15 patients (9.7%) reported early complications. Haemorrhage, usually not very profuse, occurred 7 times (4.6%), mainly in tracheopunction, and was the most often perioperative complication. Moreover, in the perioperative period, 3 patients (1.9%) had trachea identifications difficulties, which required tracheopunction many a time, and 1 patient (0.65%) encountered sudden circulatory arrest with asystolia and effective CPR. In the early postoperative period after Griggs percutaneous tracheotomy, the most common complication was haemorrhage in the operative twenty-four hours, which was noted in 10 patients (6.5%). Among other adverse complications were found: infection of the tissues near the tracheostomal region in 3 patients (1.9%), subcutaneous oedema in 1 patient (0.65%), accidental removing the tube from an unformed tracheostoma in 1 patient (0.65%). In the studied material, complications after Griggs percutaneous tracheotomy amounted to 16.8%, of which 7.1% occurred in the perioperative period while 9.7% were early complications, mainly light bleeding. This may prove good preparation of the surgical team for the surgical procedures.

Emphysematous Aortitis

Emphysematous Aortitis

Out-of-hospital cardiac arrest--the relevance of heart failure. The Maastricht Circulatory Arrest Registry.

To describe the incidence and aetiology of heart failure in out-of-hospital sudden circulatory arrest (SCA) in the Maastricht area of the Netherlands. All cases of SCA were studied in the age group 20 to 75 years between 1 January 1997 and 31 December 2000. Demographic characteristics, aetiology and clinical features, related to heart failure were studied. Four hundred and ninety-two patients were included (72% men), mean age of 62+/-10. The yearly incidence of SCA was 9.2/10,000 inhabitants. Sudden death represented 19% of all deaths, occurring in the same time period. In 52% of the men and 59% of women, SCA was the first manifestation of heart disease. In the SCA group with a cardiac history overt heart failure was present in 26% of the cases, the time interval between the first heart failure episode and SCA being 4.3+/-6.3 year. In the heart failure group the majority had previously been in a poor functional class and LVEF. Concerning aetiology, of the SCA group, 77% were known with CAD and 72% with an old MI. Also in the group with a LVEF >50% CAD was the most frequent cause. There is an increased risk of SCA at poorer pump function and most SCA victims with previous heart failure are in a poor functional class SCA. However heart failure is seen in only a minority of the SCA population. CAD is by far the most common cause of SCA.

3751 Cough cardiopulmonary resuscitation: a life-saving strategy for patients at high risk of sudden circulatory arrest

3751 Cough cardiopulmonary resuscitation: a life-saving strategy for patients at high risk of sudden circulatory arrest