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Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

, et al. Favourable survival of in-hospital compared to out-of-hospital refractory cardiac arrest patients treated with extracorporeal membrane oxygenation: an Italian tertiary care centre experience. Resuscitation. 2012;83:579-83. doi: 10.1016/j.resuscitation.2011.10.013. 6. Dworschak M. Is extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest superior compared with conventional resuscitation? Crit Care Med. 2013;41:1365-6. doi: 10.1097/CCM.0b013e31828044c0. 7. Le Guen M, Nicolas-Robin A, Carreira S, et al. Extracorporeal life

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Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview

Abstract

A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD), however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC) is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.

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New Developments in the Treatment of Acute Myocardial Infarction Associated with Out-of-Hospital Cardiac Arrest. A Review

associated with an increase in proportion of emergency crew–witnessed cases and bystander cardiopulmonary resuscitation. Circulation. 2008;118:389-396. doi: 10.1161/CIRCULATIONAHA.107.734137. 42. Vaahersalo J, Hiltunen P, Tiainen M, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med. 2013;39:826–837. doi: 10.1007/s00134-013-2868-1. 43. Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33 C versus 36 C after cardiac arrest. N Engl J Med. 2013

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The Results of Thrombolytic Treatment in Patients With High-risk Pulmonary Embolism

Abstract

Background: Mortality rates due to massive pulmonary embolism (PE) are much higher than estimated. Although thrombolytic therapy is controversial, it can be a life-saving procedure and can be safely used in patients with massive PE.

Study aim: We aimed to share the results of thrombolytic treatment in patients with massive PE.

Material and methods: We retrospectively evaluated 72 patients with PE admitted between January 2010 and April 2018 to the Department of Pulmonary Medicine, VM Medicalpark Samsun Hospital, Samsun, Turkey. The data of patients who received thrombolytic treatment were retrospectively analyzed.

Results: The female to male ratio was 24/48, with a mean age of 62.7 ± 12.6 (minimum 27, maximum 88) years. The diagnosis of massive PE was established with echocardiography in all patients and was confirmed via pulmonary CT angiography in 45 patients (62.5%) who presented an appropriate clinical status for this imaging technique. The most common symptoms were dyspnea (90.3%), chest pain (83.3%), and syncope (40.2%). The S1Q3T3 electrocardiography pattern was noted in 82% of patients, who rapidly recovered after thrombolytic therapy. Cardiopulmonary arrest was seen in 25 patients (37.2%), and thrombolytic treatment was administered during cardiopulmonary resuscitation in 18% (n = 13) of patients. The survival rate was 30.7% (n = 4) in patients with cardiopulmonary arrest who received thrombolytic treatment in the emergency room. The complications of rt-PA treatment included minor hemorrhages in 6.4% (n = 5), major hemorrhages in 2.7% (n = 2), and allergic reactions in 1.3% (n = 1) of patients. None of the patients had deceased as a complication of thrombolytic treatment. The overall mortality rate was 26.2% (n = 19), and 12.5% (n = 9) of the patients have died in first 24 hours after thrombolysis.

Conclusions: We concluded that the risk factors, ECG, and echocardiography are key indicators for the suspicion of massive PE in patients with hemodynamic shock. Based on our experience, early thrombolytic therapy is a life-saving intervention in patients with diagnosed and/or suspected massive PE.

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Clinical Update. Clinical Presentations of Pulmonary Embolism in the Emergency Department

Abstract

Pulmonary embolism (PE) is one of the most severe conditions encountered in the emergency department (ED) and one of the leading causes of cardiovascular morbidity and mortality, especially in patients presenting with hemodynamic instability, right ventricular dysfunction, or necessitating cardiopulmonary resuscitation. The early recognition and treatment of PE is essential, as many studies demonstrated that mortality rates drop significantly if adequate therapy is administered from the early stages. The aim of this update is to summarize the various patterns of PE presentations in the ED.

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Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome

;115:1354-1362. 3. Hasselqvist-Ax I, Riva G, Herlitz J et al. Early Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest. New Eng J Med. 2015;372:2307-2315. 4. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2015; pii: ehv320. [Epub ahead of print

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The ovine jugular vein as a model for interventional radiology procedures

Diseases. Surgical and Interventional Therapy, Churchill Livingstone Inc., New York 1994, 103-117. Voorhees WD 3rd, Ralston SH, Babbs CF. Regional blood flow during cardiopulmonary resuscitation with abdominal counter pulsation in dogs. Am J Emerg Med 1984; 2: 123-8. Pavcnik D, Yin Q, Uchida B, Park WK, Kim MD, Hoppe H, et al:. Percutaneous autologous venous valve transplantation: feasibility study in and ovine model. J Vasc Surg 2007; 46: 338-45. Pavcnik D, Uchida B, Kaufman JA, Hinds M

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Electrical Storm Due to Active Myocardial Ischemia in the Right Coronary Artery Territory – Case Report

storm: Incidence, Prognosis and Therapy. Indian Pacing and Electrophysiology Journal. 2011;11:34-42. 15. Link MS, Berkow LC, Kudenchuk PJ, et al. Adult advanced cardiovascular life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S444-464. doi: 10.1161/CIR.0000000000000261. 16. Santangeli P, Muser D, Maeda S, et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients

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Diagnosing “Brain Death” in Intensive Care

: Bryant CD, ed.: Handbook of death and dying. Thousand Oaks, CA: SAGE Publications, Inc, 2003; pp. 284-92. 12. Bael NA. Cardiopulmonary resuscitation on television. Exaggeration and accusation. N Engl J Med. 1996;334:1604-5. 13. Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med. 1996;334:1578-82. 14. Paris JJ, Cummings BM, Moore MP Jr. “Brain death,” “dead,” and parental denial - the case of Jahi McMath. Camb Q. Healthc Ethics. 2014

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Unknown use of end-tidal CO2 in metabolic emergencies in pediatric patients

1 Maconochie IK, de Caen AR, Aickin R, Atkins DL, Biarent D, Guerguerian AM, Kleinman ME, et al . Part 6: Pediatric basic life support and pediatric advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e147 – 68. Maconochie IK de Caen AR Aickin R Atkins DL Biarent D Guerguerian AM Kleinman ME et al Part 6: Pediatric basic life support and pediatric advanced life support: 2015 International Consensus on

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