Hemodialysis during cardiopulmonary resuscitation in patients with severe metabolic acidosis

Şahutoğlu, Tuncay; Sahutoglu, Elif

doi:10.1177/0391398818784275

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Increased cerebral blood flow means more oxygen and energy supply to the brain during CPR, which may attenuate ischemic brain injury. Furthermore, severe acidosis has been reported to not only reduce cardiac output (35,36) but also increase damage of GABAergic cells and free radical reactions in the brain, exacerbating nerve cell damage after CA (37). In the present study, our results demonstrated that the metabolic acidosis in the STD-CPR group was more severe during resuscitation, which might have resulted in more severe brain damage in the STD-CPR group compared with the AACD-CPR group.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation in Asphyctic Cardiac Arrest Rats With Multiple Rib Fractures

Dai,

Zhang,

Wang

et al. 2023

Shock

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Background Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) is potentially more effective for cardiac arrest with multiple rib fractures. However, its impact on survival rates and neurological outcomes remains unknown. This study aimed to assess if AACD-CPR improves survival rates and neurological outcomes in a rat model of asphyctic cardiac arrest with multiple rib fractures. Methods Adult male Sprague-Dawley rats were randomized into 3 groups: AACD group (n = 15), standard cardiopulmonary resuscitation (STD-CPR) group (n = 15), and sham group (n = 10), after bilateral rib fractures were surgically created and endotracheal intubation was performed. AACD-CPR and STD-CPR groups underwent 8 minutes of asphyxia followed by different CPR techniques. The sham group had venous catheterization only. Physiological variables and arterial blood gases were recorded at baseline and during a 4-hour monitoring period. Neurological deficit scores (NDS) and cumulative survival rates were assessed at 24 h, 48 h, and 72 h. NDS, serum biomarkers and hippocampal neuron analysis were used to evaluate neurological outcomes. Results No statistical differences were observed in the return of spontaneous circulation (ROSC), 24-hour, 48-hour, and 72-hour survival rates between the AACD-CPR and STD-CPR groups. AACD-CPR rats had lower serum levels of neuron-specific enolase (NSE) and S100B at 72 hours post-ROSC, and higher NDS at 72 hours post-ROSC compared to STD-CPR animals. Cellular morphology analysis, H&E staining, and TUNEL/DAPI assays showed more viable neurons and fewer apoptotic neurons in the AACD-CPR group than in the STD-CPR group. Conclusions AACD-CPR can achieve similar survival rates and better neurologic outcome after asphyxial cardiac arrest in rats with multiple rib fractures when compared to STD-CPR.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation in Asphyctic Cardiac Arrest Rats With Multiple Rib Fractures

Dai,

Zhang,

Wang

et al. 2023

Shock

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“…Signs and symptoms frequently associated with ethylene glycol intoxication include high anion gap metabolic acidosis, high osmolar gap, AKI, neurological dysfunction, and cardiopulmonary complications including cardiac arrest [ 5 ]. Treatment involves inhibition of alcohol dehydrogenase (ADH) using fomepizole or ethanol to block toxic metabolite formation and sodium bicarbonate to correct metabolic acidosis [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Ethylene Glycol Intoxication Requiring ECMO Support

Rosen

Robbins-Juarez

Stevens

2021

Case Reports in Critical Care

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Ethylene glycol is commonly used in antifreeze, and ingestion of even a small amount can result in acute kidney injury, severe metabolic acidosis, and neurological injury. When cases are recognized early, treatment involves administration of alcohol dehydrogenase inhibitors to prevent conversion to toxic metabolites of glycolate, glyoxolate, and oxalate. In later presentations with more severe renal injury, hemodialysis may be required for clearance of toxic metabolites and supportive care for renal failure. We present the first reported case of severe ethylene glycol intoxication requiring support of extracorporeal membrane oxygenation (ECMO) due to refractory cardiopulmonary collapse.

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“…69 The successful utilization of high-efficiency hemodialysis during cardiopulmonary resuscitation (CPR) in patients with severe metabolic acidosis from ethylene glycol and metformin intoxications corroborates the causeand-effect relationship between acidosis and cardiac arrest. 70 Distinguishing between acidosis as the cause, the effect, or both in cardiac arrest scenarios can be challenging in real-world practice. For instance, a case study involved a 66-year-old man undergoing orthotopic liver transplantation for alcohol-related endstage liver disease.…”

Section: Acidosismentioning

confidence: 99%

Section: Poca Due To Contractility Crisismentioning

confidence: 99%

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

Meng,

Rasmussen,

Abcejo

et al. 2023

Anesthesia &Amp; Analgesia

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Perioperative cardiac arrest (POCA) is a catastrophic complication that requires immediate recognition and correction of the underlying cause to improve patient outcomes. While the hypoxia, hypovolemia, hydrogen ions (acidosis), hypo-/hyperkalemia, and hypothermia (Hs) and toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary), and thrombosis (coronary) (Ts) mnemonic is a valuable tool for rapid differential diagnosis, it does not cover all possible causes leading to POCA. To address this limitation, we propose using the preload-contractility-afterload-rate and rhythm (PCARR) construct to categorize POCA, which is comprehensive, systemic, and physiologically logical. We provide evidence for each component in the PCARR construct and emphasize that it complements the Hs and Ts mnemonic rather than replacing it. Furthermore, we discuss the significance of utilizing monitored variables such as electrocardiography, pulse oxygen saturation, end-tidal carbon dioxide, and blood pressure to identify clues to the underlying cause of POCA. To aid in investigating POCA causes, we suggest the Anesthetic care, Surgery, Echocardiography, Relevant Check and History (A-SERCH) list of actions. We recommend combining the Hs and Ts mnemonic, the PCARR construct, monitoring, and the A-SERCH list of actions in a rational manner to investigate POCA causes. These proposals require real-world testing to assess their feasibility.

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Hemodialysis during cardiopulmonary resuscitation in patients with severe metabolic acidosis

Abstract: The addition of high-efficiency hemodialysis during cardiopulmonary resuscitation may contribute to the return of spontaneous circulation in patients with severe metabolic acidosis due to intoxication.

Cited by 5 publications

References 18 publications

Comparison Between Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation in Asphyctic Cardiac Arrest Rats With Multiple Rib Fractures

Comparison Between Active Abdominal Compression-Decompression Cardiopulmonary Resuscitation and Standard Cardiopulmonary Resuscitation in Asphyctic Cardiac Arrest Rats With Multiple Rib Fractures

Ethylene Glycol Intoxication Requiring ECMO Support

Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions

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