Unsuccessful Resuscitation Research Articles

Perimortem Cesarean Section : As Resucitative Hysterotomy On Maternal Cardiac Arrest

Maternal cardiac arrest or maternal collaps is defined as an acute event involving the cardiorespiratory systems and/or brain, resulting in a reduced or absent consciousness level (and potentially death), at any stage in pregnancy and up to six weeks after delivery. Perimortem Cesarean Section (PCS) is performed either during maternal cardiac arrest or during impending maternal cardiac arrest toresuscitate mother and fetal. Current recommendations for maternal resuscitation include performance of the procedure following five minutes of unsuccessful cardiopulmonary resuscitation. The most common aetiology of maternal collaps was know as “4 H and 4 T” (Hypovolemia, Hypoxia, Hypo/Hyperkalemia,Hypothermia; Tromboembolism, Toxicity, Tension pneumothorax, Tamponade). Resuscitation in maternal cardiac arrest is mostly similar with non-pregnant patient resuscitation. There are several considerations need to be addressed in primary survey such as endotracheal tube 1 size smaller, supplemental O2 regardless of peripheral saturation, aggressive volume resuscitation, and uterine displacement to relieve compression of the IVC.Keywords: Maternal cardiac arrest; non-pregnant patient resuscitation

Relationship of Humidity and Atmospheric Pressure With the Risk of Out-of-hospital Cardiac Arrest

Introduction: Climate change, which affects human health, is one of the most important public health concerns. Few studies have examined the effects of humidity and atmospheric pressure as risk factors on the cardiac system and Out-of-hospital Cardiac Arrest. Objective: This study aimed to determine the relationship between climatic variables (humidity and atmospheric pressure) with Out-of-hospital Cardiac Arrest , and its outcome over 3 years (2016-2018). Materials and Methods: This is an ecological time-series study. Participants were 392 patients with Out-of-hospital Cardiac Arrest referred to Hospital in Rasht City, Iran from 2016 to 2018. Meteorological data and information related to Out-of-hospital Cardiac Arrest and its consequences were collected from reliable resources and were analyzed in R software. Results: Low humidity increased the relative risk of Out-of-hospital Cardiac Arrest (OR=1.54, 95%CI: 1.001-2.69, P=0.001) and failed cardiopulmonary resuscitation (OR=1.76, 95% CI; 1.006-3.79, P=0.001). Higher atmospheric pressure was associated with increased risk of Out-of-hospital Cardiac Arrest (OR=1.16, 95%CI; 1.001-1.78, P=0.001) and unsuccessful cardiopulmonary resuscitation (OR=1.039, 95% CI; 1.005-1.91, P=0.001). Conclusion: Decreased humidity and increased atmospheric pressure are associated with an increased number of Out-of-hospital Cardiac Arrest cases and failure of cardiopulmonary resuscitation. Informing people with cardiovascular disease to avoid such weather conditions, as well as preparing the medical care team and designing early warning systems, can reduce the adverse effects of climate change on the heart.

Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology.

Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives. Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present. Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations >9 out of 10 and were all ranked top 10 communicators. During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication.

An analysis of the vascular injuries and attempted resuscitation surrounding the assassination of Martin Luther King Jr

Martin Luther King Jr was the most prominent civil rights leader in the United States in the 1960s. He was shot by an assassin in Memphis, Tennessee, on April 4, 1968. After the shooting he was taken to a local hospital where he had an unsuccessful resuscitation for a right subclavian artery transection. Despite the fact that the circumstances around the assassination have been frequently reported and reviewed in the past 50 years, the specific vascular care of the traumatic injury has not been analyzed. This paper reviews the medical aspects of the King assassination and the management of his subclavian injury.

Accidental death in a jack-knife position

Postural (or “positional”) asphyxia occurs due to a person being in a prolonged abnormal body position that prevents adequate breathing. Its diagnosis is based on several criteria, in particular the exclusion of involvement of other people and other causes of death. This case report is about a 73-year-old woman whose body was found in a jack-knifed position by her son. She was on the floor, wedged into the space between the legs and seat of a chair. The man attempted unsuccessfully to extricate her from that position and called for medical assistance. The rescuers took pictures of the scene before freeing the victim from the chair and providing unsuccessful resuscitation. External examination disclosed abrasions on the thighs and the back of the victim, which corresponded to parts of the chair, ecchymoses on the upper limbs (ascribed to the gripping attempts), conjunctival petechiae, facial congestion and swelling. Autopsy disclosed brain and lung congestion and edema and atherosclerotic coronary disease without acute cardiac lesions. All these considerations contributed to the cause of death being determined as being due to postural asphyxia.

Coping Mechanism and Stress among Emergency Department Nurses after Unsuccessful Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation (CPR) is a life-saving procedure that performed when patient’s heart stops beating. Unsuccessful resuscitation that causes death inflicted a strong emotions and feelings, also potentially developed into emotional stress for nurses. Indealingwithstress,each individual has different abilities dependon physical, psychological, behavioral or cognitive sources which called coping mechanisms. This study aimed to describe the coping mechanism and the stress level of nurses after the unsuccessful CPR, along with the relationship between those two variables. The research design used in this study was descriptive correlational with a total sample of 50 Emergency Department and Intensive Care Unit nurses taken by convenient sampling technique from one public hospital in Cimahi. To answer the research question, critical care coping mechanisms questionnaire adapted from Mulyani & Litia were used to measured nurses coping mechanisms. Meanwhile, the stress level of nurses was measured using Perceived Stress Scale (PSS). The data obtained described using frequency and percentages, while the relationship between nurses coping mechanism and the level of stress measured using Pearson’s correlation. The results showed that most 28 (56%) nurses had moderate stress levels, and most 29 (58%) nurses had adaptive coping mechanisms after unsuccessful CPR. Finally, there was a significant relationship between coping mechanism and the level of stress of emergencyandICUnursesafterunsuccessfulCPR(r=-0.348,P=0.013).Hospitals take holder expected to facilitate training and counseling regarding stress management and the use of adaptive coping mechanisms when nurses performedan unsuccessful CPR.

An Unusual Cause of Fetal Stroke: Secondary HSV Infection

Herpes simplex virus (HSV) is a recognized cause of neonatal infection, with hematologic vertical spread usually only during a primary infection. This is an unusual case with hematologic spread of an HSV 2 infection resulting in a fetal stroke, not associated with a primary outbreak during pregnancy. A 25-year-old multigravida at 26 weeks was diagnosed with a large fetal stroke. Previous ultrasounds showed normal anatomy. She had preterm labor and delivery, with unsuccessful neonatal resuscitation. Vesicular lesions were noted on the infant. Both the lesions and the cerebral spinal fluid were positive for HSV 2. She had documented HSV infection prior to pregnancy, indicating that this was due to a hematologic secondary infection, as there was no rupture of membranes or evidence of other modes of transmission. This case shows that, while unusual, HSV hematologic vertical transmission can occur in both primary and secondary infection during pregnancy. Infection screening is worthwhile in unexplained fetal strokes.

Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest After Traffic Accidents and Termination of Resuscitation

We describe the characteristics and outcomes of pediatric traumatic out-of-hospital cardiac arrest after traffic accidents and validate the termination of resuscitation clinical criteria for adult traumatic out-of-hospital cardiac arrest in pediatrics. We analyzed the records of pediatric (≤18 years) traumatic out-of-hospital cardiac arrest cases after traffic accidents in a prospectively collected nationwide database (2012 to 2016). Endpoints were 1-month favorable neurologic outcomes and 1-month survival. Validation of termination of resuscitation criteria, cardiac arrest at the scene, and unsuccessful resuscitation after cardiopulmonary resuscitation (CPR) greater than 15 minutes was performed based on specificity and positive predictive value. Of the 582 patients who were eligible for analyses, 8 (1.4%) and 20 (3.4%) had 1-month favorable neurologic outcome and survival, respectively. All patients with favorable neurologic outcomes had out-of-hospital return of spontaneous circulation, and the duration of CPR was significantly shorter than for those with unfavorable neurologic outcomes (4 versus 23 minutes; absolute difference -21.9 minutes; 95% confidence interval -36.3 to -7.4 minutes). The duration of out-of-hospital CPR beyond which the possibility of favorable neurologic outcomes and survival diminished to less than 1% was 15 minutes. For predicting unfavorable neurologic outcomes, the termination of resuscitation criteria provided a specificity of 1.00 (95% confidence interval 0.52 to 1.00) and a positive predictive value of 1.00 (95% confidence interval 0.99 to 1.00). The outcomes of pediatric patients with traumatic out-of-hospital cardiac arrest after traffic accidents were as poor as those of adults in previous studies. Out-of-hospital return of spontaneous circulation was a significant indicator of favorable outcomes, and the duration of out-of-hospital CPR beyond which the possibility of favorable neurologic outcomes and survival diminished to less than 1% was 15 minutes. Termination of resuscitation criteria provided an excellent positive predictive value for 1-month unfavorable neurologic outcomes after out-of-hospital cardiac arrest.

Deceased organ donation potential in Canada: a review of consecutive deaths in Alberta.

Transplantation is the most effective treatment for many patients with end-stage organ failure. There is a gap between the number of patients who would benefit from transplantation and availability of organs. We assessed maximum potential for deceased donation in Alberta and barriers to increasing the donation rate. All deaths that occurred in Alberta in 2015 in areas where mechanical ventilation could be provided were retrospectively identified using administrative data. Medical records were reviewed by donation coordinators and critical care physicians with expertise in donation, using a standardized tool to determine whether deceased patients could potentially have been organ donors. There were 2,706 deaths occurring in either an intensive care unit or emergency department, of which 1,252 were attributable to a non-neurologic cause: 946 involved cardiac arrests with unsuccessful resuscitation, and 57 were not mechanically ventilated. Of the remaining 451 deaths, 117 (28 donors per million population [dpmp]) either were, or could potentially have been, organ donors after neurologic determination of death (NDD). Of these, 19 (4.5 dpmp) were not appropriately identified or referred, and 45 approached families (10.8 dpmp) did not provide consent. Non-identified NDD cases accounted for a larger proportion of deaths due to neurologic causes in emergency departments (18%) than in intensive care units (2%) (P < 0.0001) and in rural (9%) compared with urban centres (3%) (P = 0.05). If routinely available, donation after circulatory death (DCD) could potentially have been possible in as many as 113 (27 dpmp) cases. Maximum deceased organ donation potential in Alberta is approximately 55 dpmp. The current donation rate has potential to increase with more widespread availability of DCD and a higher consent rate.

Unsuccessful, Unwanted, and Unwarranted Resuscitation: Exploring Ambulance Personnel Preparation and Support for Death in the Field

Introduction:In many countries, ambulance personnel are authorized to start or stop resuscitation efforts in accordance with clinical guidelines. Research shows that decisions to withhold or terminate resuscitation and manage patient death scenes can be particularly challenging.Aim:To identify preparation and support mechanisms for ambulance personnel who are authorized to withhold or terminate resuscitation efforts, and manage patient death in the field.Methods: A scoping review provided an overview of international research in this area. A qualitative exploratory study was then undertaken. Focus groups were held with senior ambulance personnel currently working in clinical education, managerial, or pastoral support roles across New Zealand.Results:Well-supported clinical experiential learning and resolved personal experiences with grief and death were considered most useful to increase self-efficacy and coping with patient death. Participants felt some of the personal and interpersonal skills needed to manage death in the field were difficult to teach. Relatively little time is spent preparing ambulance personnel for the non-technical skills associated with resuscitation decision-making, particularly communicating with family and bystanders. Ambulance personnel responses and support-needs during or after the event are idiosyncratic. Ambulance personnel appear to primarily rely on colleagues and managers checking in and offering informal debriefing.Discussion:Results from this study identify opportunities for improvement in the preparation and support of ambulance personnel faced with managing patient death in the field. Clinical experience with supportive mentoring may provide the best opportunities for learning, but novices may not get exposure to patient death in this context. Ambulance personnel may benefit from training, which includes opportunities to role-play death notification and communication with family and bystanders at the scene of a patient death. Ambulance employers should allow downtime to facilitate personalized peer and managerial support where needed.

Cardiovascular risk factors differently affect the survival of patients undergoing manual or mechanical resuscitation

BackgroundChest compression is a decisive element of cardio-pulmonary resuscitation (CPR). By applying a mechanical CPR device, compression interruptions can be minimised. We examined the efficiency of manual and device-assisted resuscitation as well as the effects of cardiovascular risk factors on the outcome of resuscitation.MethodsIn our retrospective, randomised 3-year study the data of adult patients suffering non-traumatic, out-of-hospital, sudden cardiac death (SCD) were analysed (n = 287). The data were retrieved by processing case reports, Utstein sheets and acute coronary syndrome sheets. We compared the data of patients undergoing manual (n = 232) and device-assisted resuscitation (LUCAS-2, n = 55). The primary endpoint was the on-site restoration of spontaneous circulation (ROSC).Results and conclusionIn 37% of the cases ROSC happened. With respect to ROSC an insignificantly more favourable tendency was demonstrated in the case of device-assisted resuscitation (p = 0.072). In the Lucas group, a higher success rate occurred even in the case of prolonged resuscitation. We found a better outcome in the Lucas group in the case of CPR started a longer time after the SCD (p < 0.05). A positive correlation was established between age and unsuccessful resuscitation (p = < 0.017; r = 0.125). An unfavourable correlation was observed between hypertension and the outcome of resuscitation (p = 0.018; r = 0.143). According to our results the presence of left ventricular hypertrophy poses 5.1-fold risk of unsuccessful CPR (CI: 4.97–5.29).Advanced age and structural heart diseases can play a role in the genesis of SCD. Importantly, left ventricular hypertrophy and hypertension negatively affect survival.

Optimizing Communication with Parents During and After an Unsuccessful Neonatal Resuscitation

Providers are urged to communicate adequately when having difficult conversations with parents, generally without practical suggestions. Investigate communication with parents during/after an unsuccessful neonatal resuscitation. Participants with various expertise were invited to lead a mock code (videotaped): A caesarean section was performed for foetal distress in the presence of parents (standardized actors). The manikin remained pulseless despite adequate resuscitation. The simulation session included communication with the parents after resuscitation was discontinued. 21 Evaluators scored each participant (evaluation included open-ended questions), including 13 healthcare providers and 6 parents whose baby had died in the NICU and the 2 actors (standardized parents). 31 participants were evaluated (651 evaluations): - 15 residents - 8 paramedical personnel - 3 neonatologists and 5 fellows Communications skills in 19% of participants were scored differently by parent and actor evaluators compared to others. For example, a participant asked the father to perform cardiac massage and was only judged favourably by parents; conversely some participants were given high scores by providers but used language that was not understood by parents “there is no heart”, “your baby expired”. "Top 10" communicators adopted similar behaviours. Verbal Communication: Introduced themselves; used the baby’s name; clearly mentioned the death; told parents they could not have prevented this; acknowledged parents’ emotions. Non-verbal: Listened, respected silence; established proximity (provider-parent, parent-baby); remained calm. Specific Actions: Let father approach during resuscitation; prepared parents for the death; decided when to stop resuscitation; sat down; established eye contact; answered parents’ questions; asked parents about potential visitors. During an end-of-life scenario, many simple behaviours, identified by parents and providers, can optimize provider-parent communication.

Changes in graft gene expression contribute to coagulopathy in uDCD liver transplantation

Uncontrolled DCD donors suffer cardiac arrest followed by unsuccessful resuscitation. Their livers have been successfully transplanted, though strict maintenance and selection criteria are necessary to avoid adverse outcomes, namely ischemic type biliary lesions. We demonstrated that uDCD liver recipients develop severe coagulopathy and fibrinolysis (Blasi 2016). Given the liver is the major source of clotting and fibrinolytic factors, we hypothesized that changes in gene expression may be detected in uDCD livers and provide a basis for abnormalities observed. Methods: 32 samples were taken from 16 uDCD livers: “A” before cold preservation and “B” after reperfusion. Total RNA was extracted and analyzed using microarrays; results were confirmed using RT-PCR. Finally, 61 biopsies from 38 uDCD livers were evaluated by light microscopy to rule out fibrin microthrombi. Results: Both before preservation and after reperfusion, uDCD livers had significantly upregulated expression of genes that provoke fibrinolysis and inhibit coagulation, including TPA, urokinase plasminogen activator, urokinase plasminogen activator receptor, and thrombomodulin. There was also decreased expression of genes implicated in hemostasis (vWF) and inhibition of fibrinolysis (alpha-2-macroglobulin):TableGene"A"FCFDR"B"FCFDRA2M−2.20.006−2.60.0009PLAT1.90.0022.70.0002PLAU2.00.0052.20.0008PLAUR2.50.00023.22E-5TM----1.5<0.01VWF−2.40.0004−2.10.001 Open table in a new tab On histology, no fibrin microthrombi were detected, even in cases that developed ITBL (13%). Conclusion: Changes in gene expression in uDCD livers help explain severe coagulopathy and fibrinolysis in recipients. Endogenous fibrinolysis is upregulated in these livers most at risk for ITBL, and clinical DCD protocols using TPA to help prevent ITBL should undergo critical appraisal.

Successful treatment of out-of-hospital cardiopulmonary arrest due to streptococcal toxic shock syndrome \u2013 effectiveness of extracorporeal membrane oxygenation and the rapid antigen group A streptococcus test: a case report

BackgroundStreptococcal toxic shock syndrome caused by Streptococcus pyogenes, a group A streptococcus, infection is a rare condition that rapidly progresses to multiple organ failure, shock, and death. It is thus important to promptly establish a diagnosis, provide hemodynamic support, and initiate appropriate antibiotics therapy.Case presentationA 70-year-old Asian man presented with ventricular fibrillation. Extracorporeal membrane oxygenation was initiated 20 minutes after admission after unsuccessful conventional cardiopulmonary resuscitation including five attempts of electrical cardioversion. On the sixth attempt, a sinus rhythm was obtained. A physical examination revealed a large abscess in his right gluteal region, and computed tomography showed a large low-density area in the right gluteus maximus. Blood examination revealed elevated levels of inflammatory markers, hepatic enzymes, creatinine, and creatinine kinase. Transthoracic echocardiography demonstrated diffuse hypokinesis with an ejection fraction of 25%. A subsequent coronary angiography revealed normal findings. Therefore, we diagnosed our patient as having septic shock and conducted surgical drainage. A rapid antigen group A streptococcus test yielded positive results, which necessitated treatment comprising benzylpenicillin and clindamycin. He was successfully weaned from extracorporeal membrane oxygenation and continuous hemodiafiltration 4 days later and ventilation 9 days later; he was later transferred to another hospital to receive a skin graft.ConclusionsOur case report is the first to demonstrate the successful treatment of cardiac arrest caused by streptococcal toxic shock syndrome via extracorporeal membrane oxygenation and prompt initiation of antibiotic therapy. The rapid antigen group A streptococcus test may be an effective approach to promptly diagnose streptococcal toxic shock syndrome caused by group A streptococcus infection.

A novel technique to establish hemodynamic monitoring in patients supported with extracorporeal life support systems (ECLS) for cardiopulmonary resuscitation (ECPR)

PurposeVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support conventional unsuccessful resuscitation and it is mandatory to rapidly initiate invasive hemodynamic monitoring, as soon as ECPR therapy is commenced. Commonly, this is achieved by establishing an additional arterial line via the right radial artery for invasive blood pressure measurement, but this can be challenging and risky on the one hand and might lead to erroneous measurements on the other hand. Therefore, a faster, easier, safer and more valid method for hemodynamic monitoring is pressingly needed. Methods and resultsWe exemplarily describe one in four clinical cases, where hemodynamic monitoring was rapidly established in an ECPR supported patient by modification of the usual VA-ECMO setup: as previously described, a Y connector was implemented in the arterial cannula and equipped with a hemostatic valve at its blind end. Then, a 5 F pigtail catheter was introduced, pushed forward, and connected with a pressure transducer. This approach allows for a rapid and safe measurement of central blood pressure without need for a potentially hazardous additional arterial line. ConclusionInvasive hemodynamic monitoring in critically ill patients with VA-ECMO support is easily and rapidly achievable by introducing a pigtail catheter through a modified arterial ECMO cannula. Validation of this method in larger clinical trials is warranted.

Abstract P-409: EPIDEMIOLOGY OF DEATH IN PAEDIATRIC INTENSIVE CARE UNITS (PICUS) IN A DEVELOPING COUNTRY

Aims & Objectives: Decision making at end of life for children has been the most difficult experience for families and clinician. In depth study in this field is warranted to guide provision, funding and evaluation of palliative and bereavement care for both families and healthcare professionals. To describe the epidemiology of death among tertiary care PICUs in Malaysia. Methods Secondary analysis of prospectively collected data from patients (n=5,277) admitted to PICUs affiliated with the Paediatric Intensive Care Audit Registry (PEDICARE) between August 1, 2008 and December 31, 2015. Patients included were those who died in PICU. Results There were a total of 359 deaths, with crude mortality rate of 6.8% and SMR of 1.13. Ninety-nine (28.4%) patients died following withholding or withdrawal of treatment, 224 (62.4%) died despite maximal support, and 33 (9.2%) died following an unsuccessful resuscitation attempt. Seventy percent of all deaths occurred within the first week of admission. Patients who died beyond one week length-of-stay (LOS) were more likely to be of younger age (infant), cause of death due to liver failure, have prolonged use of mechanical ventilation and inotropes, and to have died following withholding of life-sustaining treatment. Four (26.7%) of brain dead patients died after one week. Conclusions The mode of death varies in relation to heterogeneity of practises and culture across all 3 PICUs. These data have implications for future quality improvement initiatives, especially around palliative care, end-of-life decision making, and organ donation.

A possible underlying mechanism of gastric mucosal ruptures due to resuscitation efforts

Introduction. The occurrence of gastric mucosal ruptures during cardiopulmonary resuscitation (CPR) is contributed to extensive gastric distention, either due to mouth-to-mouth resuscitation or the use of a bag and mask, or inappropriate intubation that may lead to gastric hyperinflation, which then creates gastric distension and further promotes gastric rupture. The presented case suggests that there might be another mechanism ? chest compressions during CPR. Case outline. We present a case of an 84-year-old woman who died due to severe chronic ischemic heart disease after unsuccessful resuscitation. The autopsy revealed a presence of several shallow ruptures of gastric mucosa on the lesser curvature, 1?3 cm in length, with surrounding mucosal hemorrhage, and without bleeding in the gastric cavity. Conclusion. Gastric mucosal ruptures could occur due to a combination of two mechanisms: pressure propagation due to chest compression and gastric hyperinflation

Mortalité maternelle liée à l’anesthésie-réanimation. Résultats de l’ENCMM, France 2010–2012

Over the period 2010–2012, maternal mortality linked to anesthesia accounted for 2% of maternal deaths, with no significant change since 2007–2009. Of the 7 maternal deaths analyzed by the expert committee, anesthetic complications were in 5 cases the main cause of death: 4 attributed to direct causes related to anesthetic procedures during childbirth and 1 to indirect cause in connection with an ENT complication during pregnancy. The anesthetic causes of maternal mortality were for the 2010–2012 period: cardiac arrest under spinal anesthesia during caesarean section, local anesthetic intoxication with unsuccessful resuscitation after cardiac arrest without intralipid administration, acute respiratory distress syndrome in the postpartum period after pulmonary aspiration during caesarean section, cardiac arrest during caesarean section under general anesthesia in a context of non-Hodgkin lymphoma with mediastinal syndrome, unsuccessful endotracheal intubation in a context of cellulitis of the oral cavity floor. In two other cases, anesthetic complications were identified as associated causes of death, the primary cause being intracerebral hemorrhage stroke and pulmonary hypertension. In most of the cases analyzed over the period 2010–2012, anesthesia and resuscitation have been involved in the occurrence of maternal deaths, mainly through strategic errors in the management of patients with severe pathology before delivery, as well as through insufficient cardiac resuscitation duration after cardiac arrest.

Increases in Heart Rate Variability Signal Improved Outcomes in Rapid Response Team Consultations: A Cohort Study.

Background Reduced heart rate variability (HRV) indicates dominance of the sympathetic system and a state of “physiologic stress.” We postulated that, in patients with critical illness, increases in HRV might signal successful resuscitation and improved prognosis. Methods We carried out a prospective observational study of HRV on all patients referred to the rapid response team (RRT) and correlated with serial vital signs, lactate clearance, ICU admission, and mortality. Results Ninety-one patients were studied. Significantly higher HRV was observed in patients who achieved physiological stability and did not need ICU admission: ASDNN 19 versus 34.5, p=0.032; rMSSD 13.5 versus 25, p=0.046; mean VLF 9.4 versus 17, p=0.021; mean LF 5.8 versus 12.4, p=0.018; and mean HF 4.7 versus 10.5, p=0.017. ROC curves confirmed the change in very low frequencies at 2 hours as a strong predictor for ICU admission with an AUC of 0.772 (95% CI 0.633, 0.911, p=0.001) and a cutoff value of −0.65 associated with a sensitivity of 78.6% and a specificity of 61%. Conclusions Reduced HRV, specifically VLF, appears closely related to greater severity of critical illness, identifies unsuccessful resuscitation, and can be used to identify consultations that need early ICU admission.

Mortalité maternelle liée à l’anesthésie-réanimation. Résultats de l’ENCMM, France 2010–2012

Over the period 2010–2012, maternal mortality linked to anesthesia accounted for 2% of maternal deaths, with no significant change since 2007–2009. Of the 7 maternal deaths analyzed by the expert committee, anesthetic complications were in 5 cases the main cause of death: 4 attributed to direct causes related to anesthetic procedures during childbirth and 1 to indirect cause in connection with an ENT complication during pregnancy. The anesthetic causes of maternal mortality were for the 2010–2012 period: cardiac arrest under spinal anesthesia during caesarean section, local anesthetic intoxication with unsuccessful resuscitation after cardiac arrest without intralipid administration, acute respiratory distress syndrome in the postpartum period after pulmonary aspiration during caesarean section, cardiac arrest during caesarean section under general anesthesia in a context of non-Hodgkin lymphoma with mediastinal syndrome, unsuccessful endotracheal intubation in a context of cellulitis of the oral cavity floor. In two other cases, anesthetic complications were identified as associated causes of death, the primary cause being intracerebral hemorrhage stroke and pulmonary hypertension. In most of the cases analyzed over the period 2010–2012, anesthesia and resuscitation have been involved in the occurrence of maternal deaths, mainly through strategic errors in the management of patients with severe pathology before delivery, as well as through insufficient cardiac resuscitation duration after cardiac arrest.