The Resuscitation Outcome

El‐Menyar, Ayman

doi:10.1378/chest.128.4.2835

Cited by 36 publications

(7 citation statements)

References 108 publications

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“…Moreover, postresuscitation myocardial dysfunction is one of the leading causes of early death after successful CPR [22]. Echocardiography-derived variables such as left ventricular ejection fraction and E/A ratio are used routinely for assessment of myocardial function.…”

Section: Discussionmentioning

confidence: 99%

“…[24] also previously demonstrated, in a rat model of CA, that SEVO administered at the beginning of CPR was able to improve left ventricular ejection fraction, maximum cardiac power and end-diastolic volume within the first 3 hours after CPR. Since myocardial stunning has also previously been summarized as one potential underlying mechanism of postresuscitation myocardial dysfunction [22], attenuation of myocardial stunning may further be considered in terms of cardioprotective properties of SEVO postconditioning. In contrast, propofol is a widely used intravenous anesthetic agent with antioxidant properties secondary to its phenol-based chemical structure.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction

et al. 2011

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IntroductionIn this study, we sought to examine whether pharmacological postconditioning with sevoflurane (SEVO) is neuro- and cardioprotective in a pig model of cardiopulmonary resuscitation.MethodsTwenty-two pigs were subjected to cardiac arrest. After 8 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started. After successful return of spontaneous circulation (N = 16), animals were randomized to either (1) propofol (CONTROL) anesthesia or (2) SEVO anesthesia for 4 hours. Neurological function was assessed 24 hours after return of spontaneous circulation. The effects on myocardial and cerebral damage, especially on inflammation, apoptosis and tissue remodeling, were studied using cellular and molecular approaches.ResultsAnimals treated with SEVO had lower peak troponin T levels (median [IQR]) (CONTROL vs SEVO = 0.31 pg/mL [0.2 to 0.65] vs 0.14 pg/mL [0.09 to 0.25]; P < 0.05) and improved left ventricular systolic and diastolic function compared to the CONTROL group (P < 0.05). SEVO was associated with a reduction in myocardial IL-1β protein concentrations (0.16 pg/μg total protein [0.14 to 0.17] vs 0.12 pg/μg total protein [0.11 to 0.14]; P < 0.01), a reduction in apoptosis (increased procaspase-3 protein levels (0.94 arbitrary units [0.86 to 1.04] vs 1.18 arbitrary units [1.03 to 1.28]; P < 0.05), increased hypoxia-inducible factor (HIF)-1α protein expression (P < 0.05) and increased activity of matrix metalloproteinase 9 (P < 0.05). SEVO did not, however, affect neurological deficit score or cerebral cellular and molecular pathways.ConclusionsSEVO reduced myocardial damage and dysfunction after cardiopulmonary resuscitation in the early postresuscitation period. The reduction was associated with a reduced rate of myocardial proinflammatory cytokine expression, apoptosis, increased HIF-1α expression and increased activity of matrix metalloproteinase 9. Early administration of SEVO may not, however, improve neurological recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction

et al. 2011

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“…These questions have kept scientists busy for several decades. By modifying the conventional modalities of resuscitation together with new promising agents, rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal, stony heart, which is the extreme form of PAMD[ 22 ]. The actual incidence of PAMD is still unclear in the literature because of the use of different definitions, small studies population, and diversity of cardiac function assessment[ 17 ].…”

Section: Pamd Diagnosismentioning

confidence: 99%

“…The intense cytokine activity directly depresses the myocardium and induces mitochondrial dysfunction with further lactic acidosis[ 55 ]. Excess catecholamines during CPR may lead to myocardial dysfunction by several mechanisms, including calcium overload, beta-receptor downregulation and desensitization, and overproduction of toxic reactive oxygen species (ROS); the latter may end up with ischemic myocardial contracture and stony heart[ 17 , 22 , 56 ]. Figure 1 shows the mechanism and pathophysiology of post-cardiac arrest myocardial dysfunction and stony heart.…”

Section: The Multifactorial Post-cardiac Arrest Syndromementioning

confidence: 99%

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

El-Menyar,

Wahlen

2024

World J Cardiol

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The post-resuscitation period is recognized as the main predictor of cardiopulmonary resuscitation (CPR) outcomes. The first description of post-resuscitation syndrome and stony heart was published over 50 years ago. Major manifestations may include but are not limited to, persistent precipitating pathology, systemic ischemia/reperfusion response, post-cardiac arrest brain injury, and finally, post-cardiac arrest myocardial dysfunction (PAMD) after successful resuscitation. Why do some patients initially survive successful resuscitation, and others do not? Also, why does the myocardium response vary after resuscitation? These questions have kept scientists busy for several decades since the first successful resuscitation was described. By modifying the conventional modalities of resuscitation together with new promising agents, rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal, stony heart. Community awareness and staff education are crucial for shortening the resuscitation time and improving short- and long-term outcomes. Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes. This review extensively addresses the underlying pathophysiology, management, and outcomes of post-resuscitation syndrome. The pattern, management, and outcome of PAMD and post-cardiac arrest shock are different based on many factors, including in-hospital cardiac arrest vs out-of-hospital cardiac arrest (OHCA), witnessed vs unwitnessed cardiac arrest, the underlying cause of arrest, the duration, and protocol used for CPR. Although restoring spontaneous circulation is a vital sign, it should not be the end of the game or lone primary outcome; it calls for better understanding and aggressive multi-disciplinary interventions and care. The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

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“…[13][14][15][16] Increasing survival of patients from cardiopulmonary arrest requires improvement in resuscitation education. [17][18][19][20][21][22][23][24] Studies conducted in Iran and New Zealand showed that the knowledge of interns and newly qualifi ed doctors were substandard. [25][26][27] A study conducted in India showed that the knowledge of nursing students and interns about basic life support (BLS) was very poor.…”

Section: Introductionmentioning

confidence: 99%

The knowledge level of final year undergraduate health science students and medical interns about cardiopulmonary resuscitation at a university teaching hospital of Northwest Ethiopia

Gebremedhn¹,

Gebregergs²,

Anderson³

2014

World Journal of Emergency Medicine

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BACKGROUND: Cardiopulmonary resuscitation (CPR) is a life-saving technique which is used after cardiopulmonary arrest. Chance of survival after arrest will increase if it is coupled with sufficient knowledge. Final year undergraduate health science students and interns manage many trauma and critically ill patients in our hospital. Even though all students took CPR training in undergraduate course, we sometimes saw difficulties in the resuscitation of patients after cardiopulmonary arrest by undergraduate health professionals. This study was to assess the level of knowledge of undergraduate health science students and medical interns about cardiopulmonary resuscitation. METHODS: Hospital based cross-sectional study was conducted from February 1 to March 30, 2013. All undergraduate health professionals were included. The mean score of knowledge was compared for sex, original residence and department of the participants by using Student's t test and ANOVA with Scheffe's test. P values <0.05 were considered statistically signifi cant. RESULTS: Four hundred sixty-one out of 506 students were included in this study with a response rate of 91.1%. The overall mean knowledge score of final year undergraduate health science students and interns was 11.1 (SD=0.2). The mean knowledge scores of nurses, interns, health officer, midwifery, anesthesia and psychiatry nursing students were 9.84 (SD=2.5), 13.34 (SD=2.8), 9.81 (SD=3.0), 8.77 (SD=2.6), 13.31 (SD=2.7) and 8.43 (SD=2.4) respectively. CONCLUSIONS: The knowledge level of undergraduate health professionals about cardiopulmonary resuscitation was insufficient. Training about CPR for undergraduate health professionals should be emphasized.

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The Resuscitation Outcome

Cited by 36 publications

References 108 publications

Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction

Pharmacological postconditioning with sevoflurane after cardiopulmonary resuscitation reduces myocardial dysfunction

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

The knowledge level of final year undergraduate health science students and medical interns about cardiopulmonary resuscitation at a university teaching hospital of Northwest Ethiopia

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