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   2020| July-September  | Volume 10 | Issue 3  
    Online since September 22, 2020

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Real-time audio-visual feedback with handheld nonautomated external defibrillator devices during cardiopulmonary resuscitation for in-hospital cardiac arrest: A meta-analysis
Andrew C Miller, Kiyoshi Scissum, Lorena McConnell, Nathaniel East, Amir Vahedian-Azimi, Kerry A Sewell, Shahriar Zehtabchi
July-September 2020, 10(3):109-122
Objective: Restoring cardiopulmonary circulation with effective chest compression remains the cornerstone of resuscitation, yet real-time compressions may be suboptimal. This project aims to determine whether in patients with in-hospital cardiac arrest (IHCA; population), chest compressions performed with free-standing audiovisual feedback (AVF) device as compared to standard manual chest compression (comparison) results in improved outcomes, including the sustained return of spontaneous circulation (ROSC), and survival to the intensive care unit (ICU) and hospital discharge (outcomes). Methods: Scholarly databases and relevant bibliographies were searched, as were clinical trial registries and relevant conference proceedings to limit publication bias. Studies were not limited by date, language, or publication status. Clinical randomized controlled trials (RCT) were included that enrolled adults (age ≥ 18 years) with IHCA and assessed real-time chest compressions delivered with either the standard manual technique or with AVF from a freestanding device not linked to an automated external defibrillator (AED) or automated compressor. Results: Four clinical trials met inclusion criteria and were included. No ongoing trials were identified. One RCT assessed the Ambu CardioPump (Ambu Inc., Columbia, MD, USA), whereas three assessed Cardio First Angel™ (Inotech, Nubberg, Germany). No clinical RCTs compared AVF devices head-to-head. Three RCTs were multi-center. Sustained ROSC (4 studies, n = 1064) was improved with AVF use (Relative risk [RR] 1.68, 95% confidence interval [CI] 1.39–2.04), as was survival to hospital discharge (2 studies, n = 922; RR 1.78, 95% CI 1.54–2.06) and survival to hospital discharge (3 studies, n = 984; RR 1.91, 95% CI 1.62–2.25). Conclusion: The moderate-quality evidence suggests that chest compressions performed using a non-AED free-standing AVF device during resuscitation for IHCA improves sustained ROSC and survival to ICU and hospital discharge. Trial Registration: PROSPERO (CRD42020157536).
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Successful long-term limb salvage using cephalic and small saphenous vein grafts: A case report
Omer Faruk Cicek, Ersin Kadirogullari;, Eren Gunertem, Adem Diken, Adnan Yalcinkaya, Mustafa Cuneyt Cicek, Alper Uzun, Kerim Cagli
July-September 2020, 10(3):140-142
In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.
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What's new in critical illness and injury science? In situ simulation for airway management during COVID-19 in the emergency department, KMC, Manipal
A Sanjan, Vimal S Krishnan, Jayaraj Mymbilly Balakrishnan, Stanislaw P Stawicki, Freston Marc Sirur, Fatimah Lateef, Rose V Goncalves, Sagar Galwankar
July-September 2020, 10(3):105-108
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Determining pediatric fluid responsiveness by stroke volume variation analysis using ICON® electrical cardiometry and ultrasonic cardiac output monitor: A cross-sectional study
Kurniawan Taufiq Kadafi, Abdul Latief, Antonius Hocky Pudjiadi
July-September 2020, 10(3):123-128
Purpose: The purpose is to determine the adequacy fluid responsiveness by the validity and cut off point of stroke volume variation (SVV) usingelectrical cardiometry, ICON® (Osypka Medical, Berlin, Germany) and ultrasonic cardiac output monitor (USCOM) and to recognize cut off point of tidal volume in shock children with mechanical ventilation. Materials and Methods: A cross-sectional study was conducted from March 2017 to September 2017 in a single center. The selection of subject through consecutive sampling. Measurements of SVV and stroke volume (SV) using USCOM and ICON were performed before and after fluid challenge. The tidal volume of individuals was measured and recorded. Results: Analysis was performed in 45 patients with median age of 14 months and 62.2% of male population. It showed that the sensitivity and specificity of ICON were 58% and 74%, respectively. The optimal cut off point of SVV using ICON was 16.5% and the area under the curve (AUC) value was 53% (95% confidence interval [CI] 35.9%–70%), P > 0.05 and cut off point of SVV using USCOM was 33.5% with the AUC value was 70% (95% CI 52.9%–87.7%), P < 0.05. The optimal cut off point of tidal volume to fluid responsivenes was 6.8 ml/kg BW and the AUC value was 44.6% (95% CI 27.4%–61.9%), P > 0.05. Conclusion: This study showed that electrical cardiometry (ICON) is unable to assess preload and the response of fluid resuscitation in children.
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Cardiac transplantation for hypertrophic cardiomyopathy in the United States 2003–2011
Srilakshmi Vallabhaneni, Amitoj Singh, Srinidhi J Meera, Jamshid Shirani
July-September 2020, 10(3):129-133
Background: Cardiac transplant (CT) is the sole option in a minority of hypertrophic cardiomyopathy (HC) adults with refractory symptoms or end-stage disease. Aims/Methods: We aimed to examine the trends and hospital outcomes of CT in HC using 2003-2011 Nationwide Inpatient Sample database. Results: HC comprised 1.1% of CT (151 of 14,277) performed during this time period (age 45±12 years, 67% male, 79% Caucasians). Number of HC CT increased from 2003 to 2011 (odds ratio=1.174; 95% confidence interval=1.102-1.252; P<0.001). Comorbidities included congestive heart failure (76%), hypertension (23%), chronic kidney disease (23%), hyperlipidemia (19%), diabetes (13%), and coronary artery disease (10%). Acute in-hospital major adverse events occurred in 1 in 4 (23%) patient and 1 in 25 (3.8%) patients died perioperatively. Other major adverse events included allograft rejection or vasculopathy (23%), postoperative stroke or transient ischemic attack (3.5%), acute renal failure (43%), respiratory failure requiring mechanical ventilation (13%), sepsis (10%) or need for blood transfusion (10%). Compared to 1990-2004 United Network of Organ Sharing registry data (n=303), patients in current cohort had more comorbid conditions [diabetes (13%-vs-0%); chronic obstructive lung disease (9%-vs-1%); P < 0.001 for both), were more likely to be male (66%-vs-48% P<0.001), were less likely to be Caucasian (79%-vs-86%; P < 0.001) or smokers (3%-vs-17%; P < 0.001) and less often required perioperative circulatory support or hemodialysis (17%-vs-49%, P < 0.001 and 3.2%-vs-8.3%, P = 0.04, respectively). Conclusion: HC comprises a small proportion of patients undergoing CT. The annual number of CT in HC has increased in recent years at least in part due to inclusion of patients with more comorbid conditions. Transplant recipients in the current cohort, however, required less postoperative circulatory support or renal replacement therapy.
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Inadvertent direct pulmonary artery catheterization complicating the effort for subclavian venous cannulation and central venous catheter placement: A case report and review of the literature
Panagiotis Papamichalis, Evangelos Alexiou, Tilemachos Zafeiridis, Evangelia Neou, Periklis Katsiafylloudis, Spyridon Karagiannis, Dimitrios Papadopoulos, Vasileios Mourkas, Apostolia-Lemonia Skoura, George Komnos, Michail Papamichalis, Apostolos Komnos
July-September 2020, 10(3):143-147
Subclavian access is commonly used in the intensive care unit (ICU) for central venous catheterization. Many complications have been reported during the placement of central venous catheters including pneumothorax, hemothorax, hematoma, and bleeding. The direct, through the thoracic wall, catheterization of pulmonary artery is a very rare one with only three previous reports in the literature. We report a patient who was catheterized for subclavian venous catheter placement, but the imaging techniques (chest X-ray and computed tomography with reconstruction of the images) revealed the direct positioning of the catheter into the pulmonary trunk, fortunately without other adverse events for the patient. Our case report in accordance with recent review of the literature strongly emphasizes the benefits of performing ultrasound-guided interventions in ICU.
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Aggressive treatment of afterload mismatch to address left ventricular dysfunction after mitral valve repair: A case report
Charles Vinsant, Joseph Holecko, Bryan A Whitson, Katja Turner
July-September 2020, 10(3):148-151
Mitral regurgitation (MR), one of the most common valvulopathies, occurs in at least 10% of the individuals older than 75 years. The long-standing volume overload occurring in severe MR inevitably leads to left ventricular (LV) enlargement and dysfunction; untreated, severe MR can progress to heart failure and death. Hypotension following separation from cardiopulmonary bypass after mitral valve intervention should alert an anesthesiologist to consider a myriad of differential diagnoses. This includes, but is not limited to, afterload mismatch, which can contribute to severe LV dysfunction, even in patients with seemingly normal preoperative ejection fraction. We present a case of acute on chronic biventricular failure after mitral valve repair due to afterload mismatch and discuss its management intraoperatively. Admittedly, identifying the causes of hypotension to guide treatment after mitral valve surgery in patients with severe MR is challenging. High index of suspicion and transesophageal echocardiogram guidance are important for prompt diagnosis, increasing the likelihood of successful outcomes with appropriate clinical management.
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Blunt aortic dissection and bilateral internal carotid dissection in the setting of polytrauma: A case report
Akshay Shanker, Amanda Gifford, Charles Bendas, Roberto C Castillo
July-September 2020, 10(3):152-154
Severe polytrauma involving multiple organ systems presents a significant challenge to any trauma center. We present a case of a patient presenting simultaneously with a type B aortic dissection, bilateral internal carotid dissections, a brachiocephalic artery dissection, and a splenic laceration among other injuries. In this patient with both solid organ injury and vascular trauma, we discuss how multidisciplinary collaboration was required to prioritize treatment goals and determine the proper initiation of antiplatelet and anticoagulation therapies.
  - 1,270 42
Complete pulmonary recovery after COVID-19 infection requiring extracorporeal membrane oxygenation: A case report
Michael S Firstenberg, Matthew Libby, Rachele Roberts, Courtney Petersen, Jennifer Hanna
July-September 2020, 10(3):155-157
Severe pulmonary complications associated with COVID-19 infections are a substantial source of morbidity and/or mortality. Extracorporeal membrane oxygenation (ECMO) has been shown to be a potentially useful therapy in the management of severe COVID-19 infection as a means to facilitate pulmonary recovery. Despite growing evidence to demonstrate the utility of ECMO for COVID-19 respiratory failure, little is known regarding the posthospital discharge recovery and functional status of these patients. Furthermore, concerns regarding potential long-term complications, but data are lacking. We illustrate a case of a previously healthy male, who was supported on ECMO for severe COVID-19 who demonstrated what appears to be a complete subjective and objective pulmonary recovery within a short time postdischarge. Our case provides some optimisms that critically-ill COVID-19 patients might recover completely and be able to return to functional lives.
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Recent trends in hospital admissions and outcomes of cardiac Chagas disease in the United States
Amitoj Singh, Brianna Cohen, Tudor Sturzoiu, Srilakshmi Vallabhaneni, Jamshid Shirani
July-September 2020, 10(3):134-139
Background: Chagas disease (CD), caused by Trypanosoma cruzi, has been increasingly encountered as a cause of cardiovascular disease in the United States. We aimed to examine trends of hospital admissions and cardiovascular outcomes of cardiac CD (CCD). Methods: Search of 2003-2011 Nationwide Inpatient Sample database identified 949 (age 57±16 years, 51% male, 72.5% Hispanic) admissions for CCD. Results: A significant increase in the number of admissions for CCD was noted during the study period (OR=1.054; 95% CI=1.028-1.081; P<0.0001); 72% were admitted to Southern and Western hospitals. Comorbidities included hypertension (40%), coronary artery disease (28%), hyperlipidemia (26%), tobacco use (12%), diabetes (9%), heart failure (5%) and obesity (2.2%). Cardiac abnormalities noted during hospitalization included atrial fibrillation (27%), ventricular tachycardia (23%), sinoatrial node dysfunction (5%), complete heart block (4%), valvular heart disease (6%)] and left ventricular aneurysms (5%). In-hospital mortality was 3.2%. Other major adverse events included cardiogenic shock in 54 (5.7%), cardiac arrest in 30 (3.2%), acute heart failure in 88 (9.3%), use of mechanical circulatory support in 29 (3.1%), and acute stroke in 34 (3.5%). Overall, 63% suffered at least one adverse event. Temporary (2%) and permanent (3.5%) pacemakers, implantable cardioverter defibrillators (10%), and cardiac transplant (2.1%) were needed for in-hospital management. Conclusions: Despite the remaining concerns about lack of awareness of CCD in the US, an increasing number of hospital admissions were reported from 2003-2011. Serious cardiovascular abnormalities were highly prevalent in these patients and were frequently associated with fatal and nonfatal complications.
  - 1,714 53