Raluca M. Tat, Adela Golea, Ştefan C. Vesa and Daniela Ionescu
Despite fifty years of research, cardiac arrest (CA) and complications resulting from hypoxic organ injury, remains one of the most significant challenges faced by physicians, knowing that the vast majority of patients with CA have an unfavourable prognosis with a higher chance of death and severe neurological disabilities [ 1 , 2 , 3 ]. In the last few years, efforts have been focused on the best way to detect those patients who have a chance to survive and to recover.
In an attempt to identify patients who survived after resuscitated CA
Oana Antal, Elena Ștefănescu, Monica Mleșnițe, Andrei Mihai Bălan and Natalia Hagău
, informed consent was obtained from each patient or their next of kin, if the patient was unable to give consent.
Seventy-one patients with severe sepsis and septic shock, initially defined according to the Surviving Sepsis Campaign Definitions [ 6 ] and subsequently redefined according to the new Sepsis-3 definitions in sepsis and septic shock [ 7 ], were included in the study.
Patients were recruited either in the emergency department (ED) or the hospital ward.
Patients were excluded if they were >80 years old, had severe cardiac disease as
Adina N. Hadade, Caius M. Breazu, Iulian V. Ilie and Calin I. Mitre
1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801-810.
2. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):762-774.
3. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016
Janos Szederjesi, Emoke Almasy, Alexandra Lazar, Adina Huțanu, Iudita Badea and Anca Georgescu
/ Society of Critical Care Medicine”. Chest. 1992;101: 1644-55.
4. Linde-Zwirble WT, Angus DC. Severe sepsis epidemiology: Sampling, selection, and society. Crit Care. 2004;8:222-6.
5. Hervald H, Egesten A. Sepsis. Pro-Inflammatory and Anti- Inflammatory Responses. Controb Microbiol. Basel, Krager, 2011, vol 17, pp 1-11.
6. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsisand septic shock: 2012. Crit Care Med. 2013;41:580-637.
Thomas-Michael Schneider, Friederike Klenner and Franz Brettner
Background: Newly approved immunotherapeutic agents, like CTLA-4 inhibitors and antibodies against PD-1, are a promising therapeutic option in cancer therapy.
Case presentation: A 74-year-old man, with a history of advanced stage melanoma and treatment with ipilimumab, pembrolizumab and nivolumab, was admitted to the hospital due to respiratory failure with hypoxemia and dyspnoea. He rapidly developed severe acute respiratory distress syndrome (ARDS), which required treatment in the intensive care unit which included mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Computed tomographic imaging (CT) showed signs of a pneumonitis, with an ARDS pattern related to the use of PD-1 antibodies. Treating the patient with high-dose immunosuppressive steroids led to an overall improvement. He was transferred to a rehabilitation hospital and subsequently to his home.
Discussion and conclusion: This is a unique case report of a patient suffering a grade 4 adverse event under nivolumab who survived having been treated with ECMO. It highlights the possibility of associated adverse reactions as well as the use of ECMO in palliative care patients. ECMO can be of great success even in patients with malignancies, but careful decision making should be done on a case by case basis.
Janos Szederjesi, Emoke Almasy, Alexandra Lazar, Adina HuȚanu and Anca Georgescu
1. Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup; Dellinger, RP; Levy, MM; Rhodes, A et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsisand septic shock: 2012. Critical Care Medicine. 2013;41:580-637.
2. Russel, JA. The current management of septic shock. Minerva Medica. 2008;99:431-58.
3. Deutschman, CS; Tracey, KJ. Sepsis: Current dogma andnewperspectives. Immunity. 2014;40:463-75.
4. Jui J. Septic Shock. In Tintinalli JE, Stapczynski JS, Ma OJ et al. Tintinalli
Andreea Bărcan, Monica Chițu, Edvin Benedek, Nora Rat, Szilamer Korodi, Mirabela Morariu and Istvan Kovacs
Introduction: In patients with out-of-hospital cardiac arrest (OHCA) complicating an ST-segment elevation myocardial infarction (STEMI), the survival depends largely on the restoration of coronary flow in the infarct related artery. The aim of this study was to determine clinical and angiographic predictors of in-hospital mortality in patients with OHCA and STEMI, successfully resuscitated and undergoing primary percutaneous intervention (PCI).
Methods: From January 2013 to July 2015, 78 patients with STEMI presenting OHCA, successfully resuscitated, transferred immediately to the catheterization unit and treated with primary PCI, were analyzed. Clinical, laboratory and angiographic data were compared in 28 non-survivors and 50 survivors.
Results: The clinical baseline characteristics of the study population showed no significant differences between the survivors and non-survivors in respect to age (p=0.06), gender (p=0.8), the presence of hypertension (p=0.4), dyslipidemia (p=0.09) obesity (p=1), smoking status (p=0.2), presence of diabetes (p=0.2), a clinical history of acute myocardial infarction (p=0.7) or stroke (p=0.17). Compared to survivors, the non-survivor group exhibited a significantly higher incidence of cardiogenic shock (50% vs 24%, p=0.02), renal failure (64.3% vs 30.0%, p=0.004) and anaemia (35.7% vs 12.0%, p=0.02). Three-vessel disease was significantly higher in the non-survivor group (42.8% vs. 20.0%, p=0.03), while there was a significantly higher percentage of TIMI 3 flow postPCI in the infarct-related artery in the survivor group (80.% vs. 57.1%, p=0.03). The time from the onset of symptoms to revascularization was significantly higher in patients who died compared to those who survived (387.5 +/- 211.3 minutes vs 300.8 +/- 166.1 minutes, p=0.04), as was the time from the onset of cardiac arrest to revascularization (103.0 +/- 56.34 minutes vs 67.0 +/- 44.4 minutes, p=0.002). Multivariate analysis identified the presence of cardiogenic shock (odds ratio [OR]: 3.17, p=0.02), multivessel disease (OR: 3.0, p=0.03), renal failure (OR: 4.2, p=0.004), anaemia (OR: 4.07, p=0.02), need for mechanical ventilation >48 hours (OR: 8.07, p=0.0002) and a duration of stay in the ICU longer than 5 days (OR: 9.96, p=0.0002) as the most significant independent predictors for mortality in patients with OHCA and STEMI.
Conclusion: In patients surviving an OHCA in the early phase of a myocardial infarction, the presence of cardiogenic shock, renal failure, anaemia or multivessel disease, as well as a longer time from the onset of symptoms or of cardiac arrest to revascularization, are independent predictors of mortality. However, the most powerful predictor of death is the duration of stay in the ICU and the requirement of mechanical ventilation for more than forty-eight hours.
1. Kern KB. Optimal Treatment of Patients Surviving Out-of- Hospital Cardiac Arrest. JACC Cardiovasc Interv. 2012;5:597-605.
2. Steg G, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J. 2012;33:2569-619.
3. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of
Mircea Gabriel Mureșan, Ioan Alexandru Balmoș, Iudita Badea and Ario Santini
sepsis. Virulence. 2015;6(4):316-26.
44. Auma MA, Siedner MJ, Nyehangane D, et al. Malaria is an uncommon cause of adult sepsis in south-western Uganda. Malaria Journal. 2013;12:146.
45. Stearns-Kurosawa DJ1, Osuchowski MF, Valentine C, Kurosawa S, Remick DG. The pathogenesis of sepsis. Annu Rev Pathol. 2011;6:19-48.
46. Remick DG. Pathophysiology of sepsis. Am J Pathol. 2007; 170:1435–44.
47. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008
Ecaterina Scarlatescu, Dana Tomescu and Sorin Stefan Arama
PS, et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366:2055-64. doi: 10.1056/NEJMoa1202290.
25. Marti-Carvajal AJ, Sola I, Gluud C, Lathyris D, Cardona AF. Human recombinant protein C for severe sepsis and septic shock in adult and paediatric patients. Cochrane Database Syst Rev. 2012;12:Cd004388. doi: 10.1002/14651858.CD004388. pub6.
26. Casserly B, Gerlach H, Phillips GS, et al. Evaluating the use of recombinant human activated protein C in adult severe sepsis: results of the Surviving Sepsis