893 results match your criteria Pulseless Electrical Activity


COVID-19 and cardiac arrhythmias: a global perspective on arrhythmia characteristics and management strategies.

J Interv Card Electrophysiol 2020 Jun 3. Epub 2020 Jun 3.

Cooper University Hospital, Camden, NJ, USA.

Background: Cardiovascular and arrhythmic events have been reported in hospitalized COVID-19 patients. However, arrhythmia manifestations and treatment strategies used in these patients have not been well-described. We sought to better understand the cardiac arrhythmic manifestations and treatment strategies in hospitalized COVID-19 patients through a worldwide cross-sectional survey. Read More

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http://dx.doi.org/10.1007/s10840-020-00789-9DOI Listing

Cold Agglutinin Autoimmune Hemolytic Anemia Associated with Novel Coronavirus (COVID-19).

Br J Haematol 2020 May 27. Epub 2020 May 27.

Reading Hospital/ Tower Health, Department of Internal Medicine, 420 S 5th Avenue, West Reading, Pennsylvania, USA, 19611.

Cold agglutinin syndrome (CAS) is a rare disorder associated with infection, autoimmune disorders, and lymphoid malignancies. We are present a case of CAS associated with SARS-CoV-2 that causes COVID-19. A 46-year-old female presented with severe anemia and positive SARS-CoV-2 RNA PCR. Read More

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http://dx.doi.org/10.1111/bjh.16892DOI Listing

Current behavior of sudden cardiac arrest and sudden death.

Arch Cardiol Mex 2020 ;90(2):200-206

Departamento de Investigación, Sociedad Cardiovascular y Arritmias (SOCAyA), Aguascalientes, México.

Sudden cardiac arrest (SCA) and sudden death (SD) continues to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCD victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Read More

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http://dx.doi.org/10.24875/ACM.19000157DOI Listing
January 2020

Fat Embolism Syndrome Revisited: A Case Report and Review of Literature, With New Recommendations for the Anesthetized Patient.

AANA J 2020 Jun;88(3):222-228

is in the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, and the Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.

Current criteria used to make the clinical diagnosis of fat embolism syndrome were never intended to be applied to an anesthetized, mechanically ventilated patient in the operating room and, as such, may not be applicable during intraoperative care. Because of this, confusion still exists among anesthesia providers in recognizing this potentially fatal clinical condition. Our goal was to develop and then present a more exacting and rigorous grading scale, tailored specifically for the anesthetized patient, with the hope that it will aid clinicians in recognizing and successfully managing the manifestations of the syndrome. Read More

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Factors affecting the course of resuscitation from cardiac arrest with pulseless electrical activity in children and adolescents.

Resuscitation 2020 May 17;152:116-122. Epub 2020 May 17.

Department of Mathematics and Physics, University of Stavanger, Norway.

Background: Although in-hospital pediatric cardiac arrests and cardiopulmonary resuscitation occur >15,000/year in the US, few studies have assessed which factors affect the course of resuscitation in these patients. We investigated transitions from Pulseless Electrical Activity (PEA) to Ventricular Fibrillation/pulseless Ventricular Tachycardia (VF/pVT), Return of Spontaneous Circulation (ROSC) and recurrences from ROSC to PEA in children and adolescents with in-hospital cardiac arrest.

Methods: Episodes of cardiac arrest at the Children's Hospital of Philadelphia were prospectively registered. Read More

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http://dx.doi.org/10.1016/j.resuscitation.2020.05.013DOI Listing

Surviving Case of a Blowout-Type Left Ventricular Free Wall Rupture During Percutaneous Coronary Intervention for a Lateral Acute Myocardial Infarction.

Int Heart J 2020 May 15;61(3):606-610. Epub 2020 May 15.

Division of Cardiology, Department of Medicine, Nihon University School of Medicine.

A 76-year-old man suffering from chest pain was admitted to our hospital with a suspected acute myocardial infarction (AMI). Emergent coronary angiography revealed a totally occluded proximal left circumflex artery (LCX). During primary percutaneous coronary intervention, his blood pressure suddenly fell within seconds, and he developed pulseless electrical activity (PEA). Read More

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http://dx.doi.org/10.1536/ihj.19-495DOI Listing

Effect of Icd Implantation on Cardiovascular Outcomes in Patients with Cardiac Amyloidosis. A Systematic Review and Meta-Anaylsis.

J Cardiovasc Electrophysiol 2020 May 11. Epub 2020 May 11.

Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA.

Introduction: Cardiac amyloidosis is associated with a high rate of sudden cardiac death (SCD). Whether implantable cardioverter-defibrillator (ICD) use in such patients prevents SCD is uncertain. This study assesses outcomes of ICD use in patients with cardiac amyloidosis. Read More

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http://dx.doi.org/10.1111/jce.14541DOI Listing

Comparison of 10 vs 14 gauge angiocatheter for treatment of tension pneumothorax and tension induced pulseless electrical activity with hemorrhagic shock: bigger is still better.

J Trauma Acute Care Surg 2020 May 1. Epub 2020 May 1.

Navy Trauma Training Center, LAC+USC Medical Center, Los Angeles, California.

Background: Little is known regarding the effect of hemorrhagic shock on the diagnosis and treatment of tension pneumothorax (tPTX). Recently, the Tactical Combat Casualty Care (TCCC) guidelines included the 10-gauge angiocatheter (10g AC) as an acceptable alternative to the 14g AC. This study sought to compare these two devices for decompression of tPTX and rescue from tension-induced pulseless electric activity (tPEA) in the setting of a concomitant 30% estimated blood volume (EBV) hemorrhage. Read More

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http://dx.doi.org/10.1097/TA.0000000000002724DOI Listing

Electrocardiographic right ventricular strain precedes hypoxic pulseless electrical activity cardiac arrests: Looking beyond pulmonary embolism.

Resuscitation 2020 Jun 29;151:127-134. Epub 2020 Apr 29.

UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.

Aim: The role of the right ventricle (RV) in pulseless electrical activity (PEA) is poorly defined outside of pulmonary embolism. We aimed to (1) describe the continuous electrocardiographic (ECG) manifestations of RV strain (RVS) preceding PEA/Asystole in-hospital cardiac arrest (IHCA), and (2) determine the prevalence and clinical causes of RVS in PEA/Asystole IHCA.

Methods: In this retrospective cross-sectional study, we evaluated 140 patients with continuous ECG data preceding PEA/Asystole IHCA. Read More

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http://dx.doi.org/10.1016/j.resuscitation.2020.04.024DOI Listing

A warning for warming catheters: interventional radiology's role.

Diagn Interv Radiol 2020 May;26(3):245-248

Department of Surgery, Monash University, Victoria, Australia.

Concerns have been raised in the literature, regarding the risk of venous thromboembolic events associated with the use of thermoregulatory catheters. Inferior vena cava (IVC) filters are commonly used to prevent venous thromboembolic events. We demonstrate the usefulness of IVC filter placement prior to the removal of thermoregulatory warming catheters. Read More

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http://dx.doi.org/10.5152/dir.2019.19298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239355PMC

Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report.

Innovations (Phila) 2020 Mar/Apr;15(2):173-176

5506 Division of Cardiothoracic, Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA.

A 64-year-old man being evaluated for pulmonary thromboendarterectomy (PTE) preoperatively experienced pulseless electrical activity secondary to right ventricular failure while undergoing bronchoscopy. After return of spontaneous circulation, a percutaneous right ventricular assist device (RVAD) was placed through the right internal jugular vein. He continued on right ventricular support with demonstration of right ventricular recovery over the following 8 days, and subsequently underwent PTE for treatment of his primary condition. Read More

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http://dx.doi.org/10.1177/1556984520904790DOI Listing

Association of non-shockable initial rhythm and psychotropic medication in sudden cardiac arrest.

Int J Cardiol Heart Vasc 2020 Jun 22;28:100518. Epub 2020 Apr 22.

Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland.

Background: Asystole (ASY) and pulseless electrical activity (PEA) have a poor outcome during sudden cardiac arrest (SCA). Psychotropic medication has been associated with a risk for sudden cardiac death (SCD). Our aim was to study the association of psychotropic medication with ASY/PEA during SCA. Read More

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http://dx.doi.org/10.1016/j.ijcha.2020.100518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182673PMC

Outcomes of patients operated for acute type A aortic dissection requiring preoperative cardiopulmonary resuscitation.

J Card Surg 2020 Apr 27. Epub 2020 Apr 27.

Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland.

Background And Aim: Acute type A aortic dissection (AAAD) is a life-threatening condition. The emergency operation usually results in 20% perioperative mortality. If preoperative cardiopulmonary resuscitation (CPR) is necessary, there is an increase in the rate of mortality. Read More

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http://dx.doi.org/10.1111/jocs.14586DOI Listing

Prehospital Disposition and Patient Outcomes in Cardiac Arrest AFTER Resuscitation Termination Protocol Change in an Urban Setting.

Prehosp Disaster Med 2020 Jun;35(3):285-292

Department of Emergency Medicine, University of California at San Francisco, San Francisco, CaliforniaUSA.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in the United States, and efforts have been made to develop termination of resuscitation protocols utilizing clinical criteria predictive of successful resuscitation and survival to discharge. A termination of resuscitation protocol utilizing longer resuscitation time and end-tidal carbon dioxide (EtCO2) monitoring criteria for termination was implemented for Emergency Medical Service (EMS) providers in an urban prehospital system in 2017. This study examines the effect the modified termination of resuscitation protocol had on rates of patient transport to a hospital, return of spontaneous circulation (ROSC), and survival to discharge. Read More

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http://dx.doi.org/10.1017/S1049023X20000473DOI Listing

Association of Fine Particulate Matter Exposure With Bystander-Witnessed Out-of-Hospital Cardiac Arrest of Cardiac Origin in Japan.

JAMA Netw Open 2020 Apr 1;3(4):e203043. Epub 2020 Apr 1.

Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.

Importance: Out-of-hospital cardiac arrests (OHCAs) are a major public health concern and a leading cause of death worldwide. Exposure to ambient air pollution is associated with increases in morbidity and mortality and has been recognized as a leading contributor to global disease burden.

Objective: To examine the association between short-term exposure to particulate matter with a diameter of 2. Read More

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http://dx.doi.org/10.1001/jamanetworkopen.2020.3043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7165302PMC

Conversion from Nonshockable to Shockable Rhythms and Out-of-Hospital Cardiac Arrest Outcomes by Initial Heart Rhythm and Rhythm Conversion Time.

Cardiol Res Pract 2020 28;2020:3786408. Epub 2020 Mar 28.

Department of Emergency Medicine, University of Texas, Southwestern Medical Center, Dallas, TX, USA.

Background: The conversion from a nonshockable rhythm (asystole or pulseless electrical activity (PEA)) to a shockable rhythm (pulseless ventricular tachycardia or ventricular fibrillation) may be associated with better out-of-hospital cardiac arrest (OHCA) outcomes. There are insufficient data on the prognostic significance of such conversions by initial heart rhythm and different rhythm conversion time.

Methods: Among 24,849 adult OHCA patients of presumed cardiac etiology with initial asystole or PEA in the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry (version 3, 2011-2015), we examined the association of shockable rhythm conversion with prehospital return of spontaneous circulation (ROSC), survival, and favorable functional outcome (modified Rankin Scale score ≤3) at hospital discharge by initial rhythm and rhythm conversion time (time from cardiopulmonary resuscitation (CPR) initiation by emergency medical providers to first shock delivery), using logistic regression adjusting for key clinical characteristics. Read More

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http://dx.doi.org/10.1155/2020/3786408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142338PMC

The Imperfect Cytokine Storm: Severe COVID-19 with ARDS in Patient on Durable LVAD Support.

JACC Case Rep 2020 Apr 8. Epub 2020 Apr 8.

Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.

As health systems worldwide grapple with the COVID-19 pandemic, patients on durable LVAD support represent a unique population at risk for the disease. We outline such a patient who developed COVID-19 complicated by "cytokine storm" with severe ARDS and myocardial injury; and describe the challenges that arose during management. Read More

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http://dx.doi.org/10.1016/j.jaccas.2020.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142699PMC

In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China.

Resuscitation 2020 Jun 10;151:18-23. Epub 2020 Apr 10.

Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chaoyang Hospital, Beijing, China; Department of Emergency Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. Electronic address:

Objective: To describe the characteristics and outcomes of patients with severe COVID-19 and in-hospital cardiac arrest (IHCA) in Wuhan, China.

Methods: The outcomes of patients with severe COVID-19 pneumonia after IHCA over a 40-day period were retrospectively evaluated. Between January 15 and February 25, 2020, data for all cardiopulmonary resuscitation (CPR) attempts for IHCA that occurred in a tertiary teaching hospital in Wuhan, China were collected according to the Utstein style. Read More

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http://dx.doi.org/10.1016/j.resuscitation.2020.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151543PMC

Patterns in continuous pulse oximetry data prior to pulseless electrical activity arrest in the general care setting.

J Clin Monit Comput 2020 Apr 8. Epub 2020 Apr 8.

Chief Quality and Value Officer, Dartmouth-Hitchcock Health System, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

The study objective was to understand if features derived from continuous pulse oximetry data can provide advanced warning of pulseless electrical activity arrest in the general care inpatient setting. Retrospective analysis of SpO2 and pulse rate data derived from continuous pulse oximetry was performed for pulseless electrical activity (n = 38) and control (n = 42) patient cohorts. Measures of central tendency and variation over time intervals ranging from 1 min to 1 h were used for inter- and intra-group comparisons. Read More

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http://dx.doi.org/10.1007/s10877-020-00509-8DOI Listing

Epidemiology and injury patterns of aerial sports in Switzerland.

World J Orthop 2020 Feb 18;11(2):107-115. Epub 2020 Feb 18.

Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital Bern, University Bern, Bern 3010, Switzerland.

Background: Airborne sports have become more popular in recent years. The number of accidents has increased linearly as athletes take increasingly greater risks to experience the adventurous spirit of this kind of sports.

Aim: To investigate the variety of injuries in airborne sport accidents, as well as which acute treatment these patients receive, both before and after admission to a level-one-trauma center. Read More

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http://dx.doi.org/10.5312/wjo.v11.i2.107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063457PMC
February 2020

A Broken Heart: Cardiac Arrest As the Initial Presentation of Myasthenic Crisis.

Cureus 2020 Feb 5;12(2):e6891. Epub 2020 Feb 5.

Internal Medicine, Brookdale University Hospital Medical Center, New York, USA.

Myasthenic crisis is a life-threatening condition commonly associated with respiratory failure and may present in unusual ways. However, there is paucity in the literature about the cardiac manifestations of myasthenia gravis. We present a case of a 61-year-old male who presented to the emergency room with upper respiratory infection symptoms who soon thereafter suffered sudden cardiac arrest. Read More

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http://dx.doi.org/10.7759/cureus.6891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058388PMC
February 2020

Closing the Gap: Optimizing Performance to Reduce Interruptions in Cardiopulmonary Resuscitation.

Pediatr Crit Care Med 2020 Mar 10. Epub 2020 Mar 10.

Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.

Objectives: The American Heart Association recommends minimizing pauses of chest compressions and defines high performance resuscitation as achieving a chest compression fraction greater than 80%. We hypothesize that interruption times are excessively long, leading to an unnecessarily large impact on chest compression fraction.

Design: A retrospective study using video review of a convenience sample of clinically realistic in situ simulated pulseless electrical activity cardiopulmonary arrests. Read More

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http://dx.doi.org/10.1097/PCC.0000000000002345DOI Listing

Recurrent but Preventable Pulseless Electrical Activity Arrest: Follow the Guidelines!

Circ Heart Fail 2020 Mar 11;13(3):e006781. Epub 2020 Mar 11.

Department of Medicine, Division of Cardiology (A.W.C., B.A.H., R.J.T.), Medical University of South Carolina, Charleston.

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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006781DOI Listing

Bradycardia at the onset of pulseless electrical activity arrests in hospitalized patients is associated with improved survival to discharge.

Heliyon 2020 Feb 28;6(2):e03491. Epub 2020 Feb 28.

University of Washington, Division of Cardiology, USA.

Background: Recent studies have suggested that the incidence of in-hospital pulseless electrical activity (PEA) arrests is increasing. Bradycardia in patients with in-hospital PEA is common but it is unknown if it is associated with respiratory arrest or patient outcomes.

Objective: To determine risk factors and outcomes associated with bradycardic-PEA arrests, and relationship between bradycardia and respiratory arrest. Read More

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http://dx.doi.org/10.1016/j.heliyon.2020.e03491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049649PMC
February 2020

Spasm Provocation Tests under Medication May Help Decide on Medical or Mechanical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm.

Intern Med 2020 Jun 5;59(11):1351-1359. Epub 2020 Mar 5.

Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan.

Objective The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverter-defibrillator (ICD) is one option in patients with ASCD due to coronary spasm. We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Read More

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http://dx.doi.org/10.2169/internalmedicine.4158-19DOI Listing

Venous limb gangrene and pulseless electrical activity (PEA) cardiac arrest during management of deep-vein thrombosis and progressive limb ischemic necrosis following vascular surgery.

Am J Hematol 2020 Jun 20;95(6):712-717. Epub 2020 Mar 20.

Department of Pathology and Molecular Medicine, and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.

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http://dx.doi.org/10.1002/ajh.25768DOI Listing

Cerebellar Haemorrhage Leading to Sudden Cardiac Arrest.

J Crit Care Med (Targu Mures) 2020 Jan 31;6(1):71-73. Epub 2020 Jan 31.

Division of Internal Medicine, Rutgers Robert Wood Johnson Medical School, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, New Jersey 08901. USA.

Introduction: Intracranial haemorrhage (ICH) is a known, but a rare cause of out of hospital cardiac arrest (OHCA). It results in the development of non-shockable rhythms such as asystole or pulseless electrical activity (PEA).

Case Report: A 77- years old male had an OHCA without any prodrome. Read More

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http://dx.doi.org/10.2478/jccm-2020-0007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029410PMC
January 2020

Massive mass embolism detected by transesophageal echocardiography in bone cement implantation syndrome: a case report.

JA Clin Rep 2019 Jan 24;5(1). Epub 2019 Jan 24.

Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 650-0047, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.

Bone cement implantation syndrome (BCIS) is a known complication in patients undergoing cemented orthopedic surgeries; however, the etiology and pathophysiology of BCIS are not fully understood. We report the case of a patient who developed pulseless electrical activity (PEA) due to BCIS after cemented femoral head replacement. Transesophageal echocardiography (TEE) during PEA revealed a massive embolus extending from the main pulmonary artery to the inferior vena cava. Read More

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http://dx.doi.org/10.1186/s40981-019-0225-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6967219PMC
January 2019

Prehospital Epinephrine as a Potential Factor Associated with Prehospital Rearrest.

Prehosp Emerg Care 2020 Mar 6:1-10. Epub 2020 Mar 6.

To investigate the impact of epinephrine on prehospital rearrest and re-attainment of prehospital return of spontaneous circulation (ROSC). Data for 9,292 (≥ 8 years) out-of-hospital cardiac arrest (OHCA) patients transported to hospitals by emergency medical services were collected in Ishikawa Prefecture, Japan during 2010-2018. Univariate and multivariable analyses were retrospectively performed for 1,163 patients with prehospital ROSC. Read More

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http://dx.doi.org/10.1080/10903127.2020.1725197DOI Listing

Prone cardiopulmonary resuscitation in elderly undergoing posterior spinal fusion with laminectomy.

Saudi J Anaesth 2020 Jan-Mar;14(1):123-126. Epub 2020 Jan 6.

Department of Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

An 80-year-old male patient presented with 2 weeks history of low back pain undergoing posterior spinal fusion with laminectomy in the prone position. The patient was induced with fentanyl, propofol, and rocuronium, and then he was positioned in the prone position. After 6 h of starting the surgery, the patient started to be hypotension and bradycardia followed by pulseless electrical activity (PEA). Read More

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http://dx.doi.org/10.4103/sja.SJA_165_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970382PMC
January 2020

Cardiac arrest during hemodialysis: a survey of five Japanese hospitals.

Acute Med Surg 2020 Jan-Dec;7(1):e476. Epub 2020 Jan 16.

Department of Emergency and Critical Care Medicine St. Marianna University School of Medicine Kawasaki Japan.

Aim: Intraprocedural cardiac arrest is a serious complication among patients receiving hemodialysis. However, the frequency and reaction to these events remain unclear. This study aimed to explore the clinical picture of cardiac arrest during hemodialysis. Read More

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http://dx.doi.org/10.1002/ams2.476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971461PMC
January 2020

Penetrating Thoracic Injury and Fatal Aortic Transection From the Barb of a Stingray.

Wilderness Environ Med 2020 Mar 23;31(1):78-81. Epub 2020 Jan 23.

Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.

Stingrays are found in open waters and are also kept in exhibits in many aquariums throughout the world. They are generally nonaggressive creatures by nature, but they can inflict injuries with their spines if provoked. We present a case of a 62-y-old diver who was pierced in the chest by the barb of a stingray while transferring the animal to another tank as part of his work in a public aquarium. Read More

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http://dx.doi.org/10.1016/j.wem.2019.09.004DOI Listing

The differential neurologic prognosis of low-flow time according to the initial rhythm in patients who undergo extracorporeal cardiopulmonary resuscitation.

Resuscitation 2020 Mar 23;148:121-127. Epub 2020 Jan 23.

Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address:

Background: Limited data is available on the association between low-flow time and neurologic outcome according to the initial arrest rhythm in patients underwent extracorporeal cardiopulmonary resuscitation (ECPR).

Methods: Between September 2004 and December 2018, 294 patients with in-hospital cardiac arrest (IHCA) were included in this analysis. We classified the patients into asystole (n = 42), pulseless electrical activity (PEA, n = 163) and shockable rhythm (n = 89) according to their initial rhythm. Read More

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http://dx.doi.org/10.1016/j.resuscitation.2020.01.015DOI Listing

Heart failure enigma in young man: the acute onset of a frequently encountered condition with an unexpected cause.

BMJ Case Rep 2020 Jan 19;13(1). Epub 2020 Jan 19.

Department of Cardiology (Transplant & Heart Failure, Interventional), University of Miami Health System, Miami, Florida, USA.

An 18-year-old male patient presented to the emergency department complaining of new onset chest pain, fever and orthopnoea. Initial workup was remarkable for elevated troponin, diffuse ST-segment elevation on ECG and chest X-ray with enlarged cardiac silhouette. Transthoracic echocardiogram (TTE) demonstrates severe biventricular concentric hypertrophy and pericardial effusion. Read More

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http://dx.doi.org/10.1136/bcr-2019-233190DOI Listing
January 2020

Lung recruitment maneuvers: opening the door to a hidden enemy.

Rev Esp Anestesiol Reanim 2020 Feb 16;67(2):99-102. Epub 2020 Jan 16.

Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.

Recruitment manoeuvres (RM) are common practice in anaesthesiology; however, they can have adverse effects. We present an unforeseen complication in a patient undergoing surgical resection of a bronchial tumour who presented cardiac arrest due to pulseless electrical activity immediately after RMs. A transoesophageal echocardiogram performed after return of spontaneous circulation showed a patent foramen ovale (PFO), left ventricular dysfunction with segmental changes, and air in the left ventricle, leading to suspicion of paradoxical air embolism. Read More

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http://dx.doi.org/10.1016/j.redar.2019.10.010DOI Listing
February 2020

Convolutional Recurrent Neural Networks to Characterize the Circulation Component in the Thoracic Impedance during Out-of-Hospital Cardiac Arrest.

Conf Proc IEEE Eng Med Biol Soc 2019 07;2019:1921-1925

Pulse detection during out-of-hospital cardiac arrest remains challenging for both novel and expert rescuers because current methods are inaccurate and time-consuming. There is still a need to develop automatic methods for pulse detection, where the most challenging scenario is the discrimination between pulsed rhythms (PR, pulse) and pulseless electrical activity (PEA, no pulse). Thoracic impedance (TI) acquired through defibrillation pads has been proven useful for detecting pulse as it shows small fluctuations with every heart beat. Read More

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http://dx.doi.org/10.1109/EMBC.2019.8857758DOI Listing

ECG-based Random Forest Classifier for Cardiac Arrest Rhythms.

Conf Proc IEEE Eng Med Biol Soc 2019 07;2019:1504-1508

Rhythm annotation of out-of-hospital cardiac episodes (OHCA) is key for a better understanding of the interplay between resuscitation therapy and OHCA patient outcome. OHCA rhythms are classified in five categories, asystole (AS), pulseless electrical activity (PEA), pulsed rhythms (PR), ventricular fibrillation (VF) and ventricular tachycardia (VT). Manual OHCA annotation by expert clinicians is onerous and time consuming, so there is a need for accurate and automatic OHCA rhythm annotation methods. Read More

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http://dx.doi.org/10.1109/EMBC.2019.8857893DOI Listing

Helmet Sign on EKG: A Rare Indicator of Poor Prognosis in Critically Ill Patients.

Am J Med Case Rep 2019 6;7(10):260-263. Epub 2019 Aug 6.

Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203.

Background: The 'Spiked Helmet' is an electrocardiogram (EKG) finding occasionally seen in critically ill patients characterized by ST segment elevation usually represented as a 'spike and dome' pattern with elevation in the EKG baseline prior to the R wave and adjoining ST segment elevation resembling the German military helmet of the Prussian Empire. In the few cases reported in literature, this finding has been associated with very poor clinical outcomes, including in-hospital death. Although ST elevation is not uncommon in critically ill patients, these findings of a 'Spiked Helmet' sign are often transient and typically not associated with acute coronary syndrome. Read More

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http://dx.doi.org/10.12691/ajmcr-7-10-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953376PMC

Lazarus phenomenon in trauma.

Trauma Case Rep 2020 Feb 8;25:100280. Epub 2020 Jan 8.

Department of Emergency Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, United States.

Lazarus phenomenon embodies auto-resuscitation, aka the return of spontaneous circulation following termination of cardiopulmonary resuscitation. Limited or no literature exists that describes auto-resuscitation in trauma. In the current report, we describe a case of an older woman that presented with poly-traumatic injuries following a motor vehicle collision. Read More

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http://dx.doi.org/10.1016/j.tcr.2020.100280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950944PMC
February 2020

Signet Ring Cell Carcinoma with Lymphangitic Carcinomatosis in Pregnancy: A Case Report of an Unexpected Maternal Death and Review of the Literature.

Am J Case Rep 2019 Dec 17;20:1888-1891. Epub 2019 Dec 17.

Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.

BACKGROUND Cancer in pregnancy is extremely rare, and gastric cancers are rarer still. Diagnosis is difficult in pregnancy due to overlapping symptoms with pregnancy such as nausea, pain, anemia, and fatigue. CASE REPORT A 26-year-old G1 woman at 32 weeks gestation with a past medical history of systemic lupus erythematosus presented with new-onset chest pain and shortness of breath. Read More

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http://dx.doi.org/10.12659/AJCR.919412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930696PMC
December 2019

An unconscious man with profound drug-induced hypoglycaemia.

Biochem Med (Zagreb) 2020 Feb 15;30(1):010802. Epub 2019 Dec 15.

Laboratory Medicine, University Hospitals Leuven; Department of cardiovascular Medicine, University of Leuven, Leuven, Belgium.

Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known.

Case Description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1. Read More

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http://dx.doi.org/10.11613/BM.2020.010802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904963PMC
February 2020

Graves disease-induced thrombotic thrombocytopenic purpura: a case report.

J Med Case Rep 2019 Dec 13;13(1):377. Epub 2019 Dec 13.

Internal Medicine Residency Program, Department of Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, 07753, USA.

Background: Thrombotic thrombocytopenic purpura is an autoimmune disease that carries a high mortality. Very few case reports in the literature have described a relationship between Graves disease and thrombotic thrombocytopenic purpura. We present a case of a patient with Graves disease who was found to be biochemically and clinically hyperthyroid with concurrent thrombotic thrombocytopenic purpura. Read More

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http://dx.doi.org/10.1186/s13256-019-2307-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909611PMC
December 2019

Electrocardiogram-based pulse prediction during cardiopulmonary resuscitation.

Resuscitation 2020 Feb 29;147:104-111. Epub 2019 Nov 29.

Department of Medicine, University of Washington, Seattle, WA, United States; King County Emergency Medical Services, Seattle-King County Department of Public Health, Seattle, WA, United States.

Objective: Resuscitation requires CPR interruptions every 2 min to assess rhythm and pulse status. We developed a method to predict real-time pulse status in organized rhythm ECG segments with and without CPR artifact.

Methods: The study cohort included patients who received attempted resuscitation following ventricular fibrillation arrest. Read More

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http://dx.doi.org/10.1016/j.resuscitation.2019.11.021DOI Listing
February 2020

Fatal adrenal crisis due to Addison's disease arising in the context of autoimmune polyglandular syndrome type 1.

Forensic Sci Med Pathol 2020 Mar 28;16(1):166-170. Epub 2019 Nov 28.

Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53792, USA.

The autoimmune polyglandular syndromes (APS) are rare immune-mediated endocrinopathies causing destruction of multiple endocrine and non-endocrine organs. Involvement of adrenal glands associated with any type of APS results in Addison's disease. While patients with Addison's disease often suffer from symptoms of neuroglycopenia, lethal hypotension and hypoglycemia are uncommon. Read More

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http://dx.doi.org/10.1007/s12024-019-00204-4DOI Listing

In-Hospital Cardiac Arrest in the Cardiac Catheterization Laboratory: Effective Transition from an ICU- to CCU-Led Resuscitation Team.

J Interv Cardiol 2019 2;2019:1686350. Epub 2019 Sep 2.

Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.

Objectives: (1) To examine the incidence and outcomes of in-hospital cardiac arrests (IHCAs) in a large unselected patient population who underwent coronary angiography at a single tertiary academic center and (2) to evaluate a transitional change in which the cardiologist is positioned as the cardiopulmonary resuscitation (CPR) leader in the cardiac catheterization laboratory (CCL) at our local tertiary care institution.

Background: IHCA is a major public health concern with increased patient morbidity and mortality. A proportion of all IHCAs occurs in the CCL. Read More

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http://dx.doi.org/10.1155/2019/1686350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766259PMC
February 2020

Pseudo-pulseless electrical activity in the emergency department, an evidence based approach.

Am J Emerg Med 2020 Feb 14;38(2):371-375. Epub 2019 Oct 14.

Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St., Washington, DC 20037, United States. Electronic address:

Introduction: A great deal of the literature has focused specifically on true pulseless electrical activity (PEA), whereas there is a dearth of research regarding pseudo-PEA. This narrative review evaluates the diagnosis and management of patients in pseudo-PEA and discusses the impact on emerging patient outcomes.

Discussion: Pseudo-PEA can be defined as evidence of cardiac activity without a detectable pulse. Read More

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http://dx.doi.org/10.1016/j.ajem.2019.158503DOI Listing
February 2020

Synchronized Chest Compressions for Pseudo-PEA: Proof of Concept and a Synching Algorithm.

Prehosp Emerg Care 2019 Dec 19:1-9. Epub 2019 Dec 19.

The two objectives of this report are: first, to describe a comparison of chest compressions unsynchronized or synchronized to native cardiac activity in a porcine model of hypotension, and second, to develop an algorithm to provide synchronized chest compressions throughout a range of native heart rates likely to be encountered when treating PEA cardiac arrest. We adapted our previously developed signal-guided CPR system to provide compressions synchronized to native electrical activity in a porcine model of hypotension as a surrogate of PEA arrest. We describe the first comparison of unsynchronized to synchronized compressions in a single animal as a proof-of-concept. Read More

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http://dx.doi.org/10.1080/10903127.2019.1690605DOI Listing
December 2019

A Case of Pulmonary Syphilis Resulting in Multi-organ Dysfunction and Consequential Demise of a 19-Year-old Male.

Cureus 2019 Sep 3;11(9):e5560. Epub 2019 Sep 3.

Ophthalmology, San Antonio Military Medical Center, San Antonio, USA.

This case presents a young male, with a history of high-risk sexual behavior and immunosuppression, admitted with multi-organ dysfunction and pronounced dead within 24 hours of admission. After an extensive investigation, to include post-mortem studies, his symptoms were attributed to secondary syphilis, which was confirmed with high rapid plasma reagin (RPR) titers (1:128) and positive fluorescent treponemal antibody absorption test (FTA-ABS). The patient developed rapid hypoxemia and hemodynamic instability with pulseless electrical activity (PEA) arrest and was unable to be resuscitated after many rounds of cardiopulmonary resuscitation (CPR). Read More

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http://dx.doi.org/10.7759/cureus.5560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820663PMC
September 2019
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