Amber Sabeen Ahmed, Sidra Fayyaz
Hereditary angioedema (HAE) due to a C1-esterase inhibitor(C1-INH) deficiency is a rare and potentially life-threatening disorder. It is characterized by an episodic and self-limiting increase in vascular permeability. The condition manifests itself as recurrent attacks of swelling in any part of the body. The angioedema can cause the involvement of the respiratory tract, skin, and gastrointestinal tract. Laryngeal involvement can make the condition life-threatening. It does not respond well to conventional angioedema therapy of steroids, adrenaline, and antihistamines...
August 11, 2020: Curēus
Gabriel Putzer, Judith Martini, Patrick Spraider, Rouven Hornung, Daniel Pinggera, Julia Abram, Niklas Altaner, Tobias Hell, Bernhard Glodny, Raimund Helbok, Peter Mair
BACKGROUND: The influence of adrenaline during cardiopulmonary resuscitation (CPR) on the neurological outcome of cardiac arrest survivors is unclear. As little is known about the pathophysiological effects of adrenaline on cerebral oxygen delivery and cerebral metabolism we investigated its effects on parameters of cerebral oxygenation and cerebral metabolism in a pig model of CPR. METHODS: Fourteen pigs were anesthetized, intubated and instrumented. After 5 min of cardiac arrest CPR was started and continued for 15 min...
July 8, 2020: Resuscitation
Radosław Zalewski, Mateusz Puślecki, Tomasz Kłosiewicz, Maciej Sip, Bartłomiej Perek
Background: In some countries, adrenaline is available only in glass ampoules. However, simplification of cardiopulmonary resuscitation (CPR) by introducing prefilled syringes may ensure more efficient CPR. The aim of this study was to investigate the impact of different forms of adrenaline on the CPR quality. Methods: In a randomized cross-examination simulation study, 100 two-person paramedical teams took part in two 10-minute scenarios of sudden cardiac arrest (SCA) in a pulseless electrical activity mechanism (PEA)...
May 2020: Journal of Thoracic Disease
Hyoung Youn Lee, Najmiddin Mamadjonov, Kyung Woon Jeung, Yong Hun Jung, Byung Kook Lee, Kyung-Sub Moon, Tag Heo, Yong Il Min
PURPOSE: Pralidoxime potentiated the pressor effect of adrenaline and facilitated restoration of spontaneous circulation (ROSC) after prolonged cardiac arrest. In this study, we hypothesised that pralidoxime would hasten ROSC in a model with a short duration of untreated ventricular fibrillation (VF). We also hypothesised that potentiation of the pressor effect of adrenaline by pralidoxime would not be accompanied by worsening of the adverse effects of adrenaline. METHODS: After 5 min of VF, 20 pigs randomly received either pralidoxime (40 mg/kg) or saline, in combination with adrenaline, during cardiopulmonary resuscitation (CPR)...
June 19, 2020: Cardiovascular Drugs and Therapy
B Poros, J Katchanov, A Curta, T Weig
Hypersensitivity reactions are one of the most feared side effects associated with the use of CT contrast agents. Bronchospasm and lung edema are known manifestations, whereby the latter occurs much less often. In anaphylaxis, numerous mechanisms can lead to cardiac failure with subsequent lung edema. In contrast, the cardiac function is not impaired in noncardiogenic pulmonary edema (NCPE), which is a rare phenomenon but with potentially fatal outcome. The exact pathophysiology of NCPE remains unknown and characteristically response to conventional anaphylaxis treatment is poor...
August 2020: Der Anaesthesist
Ed England, Charles D Deakin, Jerry P Nolan, Ranjit Lall, Tom Quinn, Simon Gates, Joshua Miller, Lyndsey O'Shea, Helen Pocock, Nigel Rees, Charlotte Scomparin, Gavin D Perkins
AIM: To assess and evaluate patient safety incidents and in particular, medication errors, during a large multi-center pre-hospital trial of emergency therapy (PARAMEDIC2), in order to inform and improve future pre-hospital medicines trials. METHODS: The PARAMEDIC2 trial was undertaken across five NHS Ambulance Services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out -of-hospital cardiac arrest unresponsive to initial resuscitation were randomly assigned to 1 mg intravenous adrenaline or matching placebo...
June 14, 2020: European Journal of Clinical Pharmacology
Liyu Ran, Jinglun Liu, Hideharu Tanaka, Michael W Hubble, Takyu Hiroshi, Wei Huang
Background The use of adrenaline in out-of-hospital cardiac arrest (OHCA) patients is still controversial. This study aimed to determine the effects of early pre-hospital adrenaline administration in OHCA patients. Methods and Results PubMed, EMBASE, Google Scholar, and the Cochrane Library database were searched from study inception to February 2019 to identify studies that reported OHCA patients who received adrenaline. The primary outcome was survival to discharge, and the secondary outcomes were return of spontaneous circulation, favorable neurological outcome, and survival to hospital admission...
May 22, 2020: Journal of the American Heart Association
Hiromichi Naito, Tetsuya Yumoto, Takashi Yorifuji, Yoshio Tahara, Naohiro Yonemoto, Hiroshi Nonogi, Ken Nagao, Takanori Ikeda, Naoki Sato, Hiroyuki Tsutsui
BACKGROUND: Emergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs' effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes...
May 15, 2020: Resuscitation
Chaiyaporn Yuksen, Phatthranit Phattharapornjaroen, Woranee Kreethep, Chonnakarn Suwanmano, Chestsadakon Jenpanitpong, Rawin Nonnongku, Yuwares Sittichanbuncha, Kittisak Sawanyawisuth
OBJECTIVE: This study aimed to determine additional predictors of cardiopulmonary resuscitation success using a national emergency medical services (EMS) database. METHODS: This retrospective study was conducted by retrieving data from the Information Technology of Emergency Medical Service, a national EMS database. The inclusion criteria were adult patients (18 years old or over) who suffered from out-of-hospital cardiac arrest and received emergency life support...
January 2020: Turkish Journal of Emergency Medicine
Mikael F Vallentin, Asger Granfeldt, Mathias J Holmberg, Lars W Andersen
PURPOSE OF REVIEW: The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation. RECENT FINDINGS: Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival...
June 2020: Current Opinion in Critical Care
Chaiyaporn Yuksen, Phatthranit Phattharapornjaroen, Woranee Kreethep, Chonnakarn Suwanmano, Chestsadakon Jenpanitpong, Rawin Nonnongku, Yuwares Sittichanbuncha, Kittisak Sawanyawisuth
Background: Out-of-hospital cardiac arrest is the main issue for pre-hospital emergency care. There are several airway managements during the out-of-hospital cardiopulmonary resuscitation (CPR) such as endotracheal intubation (ETI) or alternative airway device: bag-valve mask (BVM). Data comparing both methods showed inconclusive results on survival and limited results on CPR outcome. This study aimed to add additional results on comparing the ETI and BVM in cardiac arrest outside hospitals; focused on the CPR outcome...
2020: Open Access Emergency Medicine: OAEM
Satoshi Matsui, Tomotaka Sobue, Taro Irisawa, Tomoki Yamada, Koichi Hayakawa, Kazuhisa Yoshiya, Kazuo Noguchi, Tetsuro Nishimura, Takuya Ishibe, Yoshiki Yagi, Takeyuki Kiguchi, Masafumi Kishimoto, Hiroshi Shintani, Yasuyuki Hayashi, Taku Sogabe, Takaya Morooka, Haruko Sakamoto, Keitaro Suzuki, Fumiko Nakamura, Norihiro Nishioka, Yohei Okada, Tasuku Matsuyama, Junya Sado, Takeshi Shimazu, Ryojiro Tanaka, Hiroshi Kurosawa, Taku Iwami, Tetsuhisa Kitamura
The effect of post-cardiac arrest care in children with out-of-hospital cardiac arrest (OHCA) has not been adequately established, and the long-term outcome after pediatric OHCA has not been sufficiently investigated. We describe here detailed in-hospital characteristics, actual management, and survival, including neurological status, 90 days after OHCA occurrence in children with OHCA transported to critical care medical centers (CCMCs).We analyzed the database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITICAL) study, which is a multicenter, prospective observational data registry designed to accumulate both pre- and in-hospital data on OHCA treatments...
March 14, 2020: International Heart Journal
Yuki Sahashi, Tatsuma Serge Yanagimoto, Susumu Endo, Hiroaki Ushikoshi, Hiroyuki Okura
We herein report a 26-year-old woman with sudden cardiac arrest who had no remarkable medical history. While resuscitation was successfully performed with adrenalin administration and extracorporeal membrane oxygenation, the cause of cardiac arrest could not be determined for over two weeks. Given the presence of autoimmune disease along with the findings of refractory renal insufficiency and thrombocytopenia, a kidney biopsy and blood examinations, including lupus anticoagulant testing, were performed, which proved the presence of antiphospholipid syndrome...
June 1, 2020: Internal Medicine
Judith Finn, Ian Jacobs, Teresa A Williams, Simon Gates, Gavin D Perkins
No abstract text is available yet for this article.
2020: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
Ryan W Morgan, Robert A Berg
No abstract text is available yet for this article.
April 2020: Resuscitation
Jerry P Nolan, Charles D Deakin, Chen Ji, Simon Gates, Andy Rosser, Ranjit Lall, Gavin D Perkins
PURPOSE: To compare the effectiveness of the intravenous (IV) and intraosseous (IO) routes for drug administration in adults with a cardiac arrest enrolled in the Pre-Hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest (PARAMEDIC2) randomised, controlled trial. METHODS: Patients were recruited from five National Health Service Ambulance Services in England and Wales from December 2014 through October 2017...
May 2020: Intensive Care Medicine
Ikuo Ota, Yoshie Kubota, Toshifumi Uejima, Hironori Shigeoka, Atsushi Hiraide
Aim: The objective of this study was to focus on outcomes of anaphylaxis-associated out-of hospital cardiac arrest (OHCA) in non-cardiac cases. Methods: All residents with OHCA due to non-cardiac cause in Japan from 2013 to 2015 were included for analysis. Propensity score matching and logistic regression analyses were used to assess outcome-related factors in anaphylaxis cases and non-anaphylaxis cases. The comparison group was comprised of non-anaphylaxis cases, which consisted of other cases of non-cardiac etiology...
January 2020: Acute Medicine & Surgery
Sally A N Gowers, Isabelle C Samper, De-Shaine R K Murray, Georgia K Smith, Sarah Jeyaprakash, Michelle L Rogers, Michael Karlsson, Markus Harboe Olsen, Kirsten Møller, Martyn G Boutelle
This work describes a fully-integrated portable microfluidic analysis system for real-time monitoring of dynamic changes in glucose and lactate occurring in the brain as a result of cardiac arrest and resuscitation. Brain metabolites are sampled using FDA-approved microdialysis probes and coupled to a high-temporal resolution 3D printed microfluidic chip housing glucose and lactate biosensors. The microfluidic biosensors are integrated with a wireless 2-channel potentiostat forming a compact analysis system that is ideal for use in a crowded operating theatre...
January 27, 2020: Analyst
Yongshu Zhang, Jieming Zhu, Zhihao Liu, Liwen Gu, Wanwan Zhang, Hong Zhan, Chunlin Hu, Jinli Liao, Yan Xiong, Ahamed H Idris
BACKGROUND: Adrenaline is an important component in the resuscitation of individuals experiencing out-of-hospital cardiac arrest (OHCA). The 2018 Advanced Cardiac Life Support (ACLS) algorithm gives the option of either intravenous (IV) or intraosseous (IO) routes for adrenaline administration during cardiac arrest. However, the optimal route during prehospital resuscitation remains controversial. This study aims to investigate whether IV and IO routes lead to different outcomes in OHCA patients who received prehospital adrenaline...
April 2020: Resuscitation
Elizabeth G Ryan, Nigel Stallard, Ranjit Lall, Chen Ji, Gavin D Perkins, Simon Gates
BACKGROUND: Phase III trials often require large sample sizes, leading to high costs and delays in clinical decision-making. Group sequential designs can improve trial efficiency by allowing for early stopping for efficacy and/or futility and thus may decrease the sample size, trial duration and associated costs. Bayesian approaches may offer additional benefits by incorporating previous information into the analyses and using decision criteria that are more practically relevant than those used in frequentist approaches...
January 14, 2020: Trials
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