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Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

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World Journal of Emergency Medicine 2024年第1期15卷 3-9页

作者： Rashed Alremeithi Quincy K.Tran Megan T.Quintana Soroush Shahamatdar Ali Pourmand department of Emergency Medicine George Washington University School of Medicine and Health SciencesWashington DC 20037USA department of Emergency Medicine University of Maryland School of MedicineBaltimore 21201USA Program in Trauma the R Adams Cowley Shock Trauma CenterUniversity of Maryland School of MedicineBaltimore 21201USA Center for Trauma and Critical Care Department of Surgerythe George Washington University School of Medicine&Health SciencesWashington DC 20037USA

BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refi ned by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arres

关键词： Traumatic cardiac arrest Emergency thoracotomy Resuscitative endovascular balloon occlusion of the aorta

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Left ventricular thrombosis caused cerebral embolism during venoarterial extracorporeal membrane oxygenation support: A case report

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World Journal of Clinical Cases 2024年第5期12卷 973-979页

作者： Yao-Bang Bai Feng Zhao Zhen-Hua Wu Guo-Ning Shi Nan Jiang Intensive Care Unit Department of Cardiac SurgeryTianjin Chest HospitalTianjin 300222China department of cardiac Surgery Tianjin Chest HospitalTianjin 300222China

BACKGROUND Venoarterial(VA)extracorporeal membrane oxygenation(ECMO),an effective short-term circulatory support method for refractory cardiogenic shock,is widely applied.However,retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%.Embolization in important organs caused by complications of left ventricular thrombosis(LVT)during VA-ECMO is also an important reason.Although the incidence of LVT during VA-ECMO is not high,the consequences of embolization are disastrous.CASE SUMMARY A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d.After excluding the diagnosis of coronary heart disease,we established a diagnosis of“clinically explosive myocarditis”.The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO,with heparin for anticoagulation.On day 4 of ECMO support,a left ventricular thro-mbus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography.Left ventricular decompression was performed and ECMO was successfully removed,but the patient eventually died of multiple cerebral embolism.CONCLUSION LVT with high mobility during VA-ECMO may cause embolism in important organs.Therefore,a"wait and see"strategy should be avoided.

关键词： Venoarterial extracorporeal membrane oxygenation Left ventricular thrombosis Cerebral embolism Magnetic Resonance Imaging Therapy Case report

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Early endotracheal intubation is not associated with the rate of return of spontaneous circulation following cardiac arrest at the emergency department:an exploratory analysis

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World Journal of Emergency Medicine 2024年第4期15卷 297-300页

作者： Siwat Neamjun Phichayut Phinyo Borwon Wittayachamnankul Wachira Wongtanasarasin department of Emergency Medicine Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand department of Family Medicine Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand Center for Clinical Epidemiology and Clinical Statistics Faculty of MedicineChiang Mai UniversityChiang Mai 50200Thailand department of Emergency Medicine University of California Davis School of MedicineSacramento 95817USA

cardiac arrest poses a significant global public health challenge,manifesting in approximately 550,000 cases annually within the United States.[1]In-hospital cardiac arrest(IHCA)is commonly attributed to airways and respiratory issues.[2]Recommendations emphasize the expertise of responders in airway management.[3]Various options exist,such as chest compression-only cardiopulmonary resuscitation(CPR),bag-mask ventilation(BMV),and advanced airways.The BMV and advanced airways are not deemed equivalent or superior based on previous evidence.[4]Achieving consistency in choosing and timing the optimal airway approach during IHCA is crucial.The current American Heart Association guidelines suggest an advanced airway strategy when endotracheal intubation(ETI)success rates are high,but the optimal time for advanced airway management remains unclear.[5]Wong et al[6]revealed that survival improved by less than 5 min with advanced airway management.According to a subgroup analysis of IHCA patients in emergency departments(EDs),early intubation was associated with a 1.5-fold greater rate of return of spontaneous circulation(ROSC)than in other locations.[7]ED patients’constant monitoring and immediate management,with readily available intubation equipment,enhance early intubation and survival rates.[6]Nonetheless,IHCA patients intubated within the first 15 min had a lower ROSC rate.

关键词： intubation return annually

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Incidence, risk factors and clinical outcome of multidrug-resistant organisms after heart transplantation

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World Journal of Transplantation 2024年第2期14卷 107-118页

作者： Sophia Hatzianastasiou Paraskevas Vlachos Georgios Stravopodis Dimitrios Elaiopoulos Afentra Koukousli Josef Papaparaskevas Themistoklis Chamogeorgakis Kyrillos Papadopoulos Theodora Soulele Despoina Chilidou Kyriaki Kolovou Aggeliki Gkouziouta Michail Bonios Stamatios Adamopoulos Stavros Dimopoulos Microbiology department and Infection Control Office Onassis Cardiac Surgery CenterAthens 17674Greece Heart Transplantation Unit Onassis Cardiac Surgery CenterAthens 17674Greece cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece

BACKGROUND Transplant recipients commonly harbor multidrug-resistant organisms(MDROs),as a result of frequent hospital admissions and increased exposure to antimi-crobials and invasive procedures.AIM To investigate the impact of patient demographic and clinical characteristics on MDRO acquisition,as well as the impact of MDRO acquisition on intensive care unit(ICU)and hospital length of stay,and on ICU mortality and 1-year mortality post heart transplantation.METHODS This retrospective cohort study analyzed 98 consecutive heart transplant patients over a ten-year period(2013-2022)in a single transplantation center.Data was collected regarding MDROs commonly encountered in critical care.RESULTS Among the 98 transplanted patients(70%male),about a third(32%)acquired or already harbored MDROs upon transplantation(MDRO group),while two thirds did not(MDRO-free group).The prevalent MDROs were Acinetobacter baumannii(14%),Pseudomonas aeruginosa(12%)and Klebsiella pneumoniae(11%).Compared to MDRO-free patients,the MDRO group was characterized by higher body mass index(P=0.002),higher rates of renal failure(P=0.017),primary graft dysfunction(10%vs 4.5%,P=0.001),surgical re-exploration(34%vs 14%,P=0.017),mechanical circulatory support(47%vs 26%P=0.037)and renal replacement therapy(28%vs 9%,P=0.014),as well as longer extracorporeal circulation time(median 210 vs 161 min,P=0.003).The median length of stay was longer in the MDRO group,namely ICU stay was 16 vs 9 d in the MDRO-free group(P=0.001),and hospital stay was 38 vs 28 d(P=0.006),while 1-year mortality was higher(28%vs 7.6%,log-rank-χ2:7.34).CONCLUSION Following heart transplantation,a predominance of Gram-negative MDROs was noted.MDRO acquisition was associated with higher complication rates,prolonged ICU and total hospital stay,and higher post-transplantation mortality.

关键词： Heart transplantation Multi drug resistant organisms Transplantation complications Transplantation outcome

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Management of a patient with an unusual trajectory of a temporary trans-venous pacing lead

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World Journal of Cardiology 2024年第6期16卷 314-317页

作者： Metesh Acharya Ethan Kavanagh Sheena Garg Davorin Sef Fabio De Robertis department of cardiac Surgery University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom department of cardiac Surgery King’s College LondonLondon WC2R 2LSUnited Kingdom department of cardiac Surgery Royal Brompton and Harefield HospitalsLondon UB96JHUnited Kingdom

Perforation of the right ventricle during placement of pacing wires is a welldocumented complication and can be potentially fatal.Use of temporary pacemaker,helical screw leads and steroids use prior to implant are recognised as risk factors for development of post-permanent pacemaker effusion.We reported an unusual case of pacing wire perforating interventricular septum into the left ventricle that occurred during the implant procedure performed in another institution.After the preoperative work-up and transfer to our tertiary cardiothoracic centre,the patient underwent successful surgical management.In conclusion,early recognition and timely diagnosis using advanced multimodality imaging can guide surgical intervention and prevent unfavourable consequences of device-related complications.

关键词： Ventricular perforation Lead perforation Pacing

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Experimental Study on Modified Treatment andEndothelialization of Bovine Pericardial Valves

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Journal of Huazhong University of Science and Technology(Medical Sciences) 1997年第3期17卷 136-139页

作者：傅平蓝鸿钧汪东仿管汉屏 department of cardiac Surgery Xiehe Hospital Tongji Medical University Wuhan

The purpose of this study were to confirm whether the modified treatment with L-glutamic acid could attenuate the calcification of the GA-fixed valves and improve its biocompatibility. Pericardial valves were routinely treated with GA and valves were treated with GA and 8% L-glutamic acid. The valves treated with these methods were implanted subcutaneously in rats. Calcium deposits of the valves collected at the 7th, 21st, 60th, 90th day were assessed by atomic absorption spectroscopy, and the pathologic changes were examined by light and electron microscopy. Cultured endothelial cells (ECs ) were seeded onto the valves. The cell counts were determined at the 1st. 4th, 7th, 10th day after seeding. PGI2 in culture medium was tested at the 10th day. Transmission and scanning electron microscopy were used to observe the growth of ECs on the valves.Results showed that subsequent treatment with L-glutamic acid could significantly mitigate calcification of bovine pericardial valves as compared with simple GAfixed valves (P<0. 01). ECs seeded on the GA treated valves died within 4 days.On the valves treated by modified method, ECs could proliferate and release PGI2. It is concluded that treatment with L- glutamic acid can markedly inhibit the calcification and improve the biocompatibility of bioprosthetical valves.

关键词： calcification bioprosthesis L-glutamic acid

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Effects of Stromal-derived Factor 1 Preconditioning on Apoptosis of Rat Bone Mesenchymal Stem Cells

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2009年第4期29卷 423-426页

作者：陈军杜心灵张凯伦 department of cardiac Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and Technology

The effects of stromal-derived factor 1 preconditioning （PC） on apoptosis of bone mesenchymal stem cells （BMSCs） treated with hypoxia plus serum deprivation were investigated. Bone mesenchymal stem cells were cultured with the whole marrow-adherence technique. RT-PCR and immunohistochemistry were used to detect the expression of CXCR4. BMSCs were incubated in medium for 24 h with 10 ng/mL and 100 ng/mL SDF-1 respectively, and then they were treated with hypoxia plus serum deprivation for 6 h. Apoptosis rate was determined by flow cytometry and TUNEL method. The results showed that BMSCs had CXCR4 expression. The number of apoptotic cells was significantly reduced in SDF-1 PC group as compared with the control group, and 100 ng/mL SDF-1 PC group had the lowest level of apoptosis. It was concluded that SDF-1 preconditioning suppresses the apoptosis of BMSCs treated with hypoxia plus serum deprivation.

关键词： bone mesenchymal stem cells SDF-1 preconditioning apoptosis

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Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

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World Journal of Cardiology 2024年第4期16卷 186-190页

作者： Akash Batta Juniali Hatwal department of Cardiology Dayanand Medical College and HospitalLudhiana 141001India department of Internal Medicine Advanced Cardiac CentrePost Graduate Institute of Medical Education&ResearchChandigarh 160012India

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that stil

关键词： Biventricular pacing cardiac resynchronization therapy Conduction system pacing Left bundle branch-area pacing Left bundle branch block Electromechanical dssynchrony

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Total Cavopulmonary Connection for Complex cardiac Anomalies with the Functional Single Ventricle

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2001年第2期21卷 149-151页

作者：蒋雄刚孙宗全张凯伦傅平 department of cardiac Surgery Institute of Cardiovascular Diseases Tongji Medical College Huazhong University of Science and Technology Wuhan

From Aug. 1999 to Feb. 2001, 8 patients with complex congenital heart diseases, including 5 cases accompanied by hypoplastic left ventricle and 3 by hypoplastic right ventricle, were subjected to total cavopulmonary connection . Eight cases underwent the operation under cardiopulmonary bypass and 7 of whom under no cardiac clamp. Seven cases received cavopulmoanry anastomosis by flaring method and one case by end side anastomosis. All the patients underwent the intracardiac tunnels to drain inferior vena cava and plus 4 mm fenestration except one. The results showed that 6 patients had postoperative oxygen saturation more than 90 %, sinus rhythm, no anastomostic stoma obstruction, no flow reguigitation and CVPcardiac failure and anoxima. It was concluded that TCPC was an effective treatment for complex congenital cardiac diseases, especially with ventricular maldevelopment. Intracardiac tunnel plus 4 mm fenestration and flaring cavopulmonary anastomosis could prevent the postoperative complications. Larger anastomotic stoma, venous pressure less than 16 cmH 2O and artery saturation more than 90 % might indicate excellent TCPC procedures in our experience.

关键词： total cavopulmonary connection ventricular maldevelopment

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Transcatheter aortic valve replacement: A journey of two decades and beyond

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中华医学杂志(英文版) 2024年第9期137卷 1012-1015页

作者： Xiong Tianyuan Chen Mao department of Cardiology West China Hospital Sichuan University Chengdu Sichuan China Laboratory of cardiac Structure and Function Institute of Cardiovascular Diseases West China Hospital Sichuan University Chengdu Sichuan China

The number of patients with calcific aortic stenosis (AS) is 9.4 million according to 2019 Global Disease Burden estimates,which will continue to increase as the population ages.For the treatment of symptomatic severe AS,transcatheter aortic valve replacement (TAVR) has evolved to be a well-established option across all risk spectra,with a rapid growth of procedures worldwide.The rise of TAVR initiates the revolution of the management of valvular heart diseases,from patient surveillance,the staging of disease,the use of multimodality imaging,the concept of the Heart Team,new designs and iterations of devices to technical innovations and the discovery of unmet clinical needs.As a consequence of the global adoption of TAVR,geographical differences in the epidemiology of AS and patient characteristics have also been further identified.An examination of the changing patient population,current applications and breakthroughs,and remaining challenges are crucial for the future of this technique.Herein,we discuss the temporal utilization of TAVR,the accumulation of evidence and progress of devices,the selection of patients,and some ongoing topics concerning the improvement of TAVR.

关键词： CEREBRAL EMBOLIC PROTECTION OUTCOMES TAVR

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