1.
Evaluation of the cardioprotective effects of crystalloid del Nido cardioplegia solution via a rapid and accurate cardiac marker: heart-type fatty acid-binding protein.
Kirişci, M, Koçarslan, A, Altintaş Aykan, D, Alkan Baylan, F, Doğaner, A, Orak, Y
Turkish journal of medical sciences. 2020;(4):999-1006
Abstract
BACKGROUND/AIM: Our aim in this study was to compare the efficacy and safety of crystalloid del Nido solution and cold blood cardioplegia solution on clinical and laboratory parameters. MATERIALS AND METHODS Sixty patients who underwent elective coronary bypass operation between July 2019 and January 2020 were included in our study. Patients were divided into 2 groups of 30 patients using del Nido solution (DNS) and cold blood cardioplegia solution (CBCS), which were given for cardiac arrest. Demographic data, preoperative, postoperative 0th h, 6th h and 4th day creatine kinase myocardial band (CK-MB) and troponin I values were compared with a specific cardiac enzyme heart-type fatty acid-binding protein (H-FABP). RESULTS We found that aortic cross clamp duration and cardiopulmonary bypass (CPB) time were shorter in patients using del Nido solution than cold blood cardioplegia solution (57.30 ± 23.57 min, 76.07 ± 27.18 min, P = 0.006) (95.07 ± 23.06 min, 114.13 ± 33.93, P = 0.014). Total cardioplegia solution volume was higher in the cold blood cardioplegia solution group (1426.67 ± 416.00 vs. 1200 ± 310.73 P = 0.02). Preoperative and postoperative levels of cardiac enzymes including CK-MB, troponin I and H-FABP were comparable in del Nido solution and cold blood cardioplegia solution groups. CONCLUSION According to these results, when we compare both demographic data and CK-MB, troponin I and H-FABP levels, both cardioplegia solutions were comparable regarding safety and efficacy in terms of myocardial protection.
2.
[Efficacy and safety of early rapid infusion of icy normal saline in patients after cardiopulmonary resuscitation].
Li, H, Li, Y, He, W, Wang, Z
Zhonghua wei zhong bing ji jiu yi xue. 2014;(10):710-3
Abstract
OBJECTIVE To assess the feasibility, safety, and effectiveness of early rapid icy normal saline infusion to attain mild hypothermia in cardiac arrest patients. METHODS A single-center prospective randomized controlled trial was conducted. From March 2011 to October 2013, patients who had recovery of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) in Beijing Daxing District People's Hospital were randomly divided into two groups. In icy normal saline group, patients received a rapid infusion of 1 000 mL of 4 centigrade normal saline intravenously to attain a mild hypothermia. In the control group, the patients were treated with ice bag on head, and axillary temperature was monitored. For all patients, rectal temperature was measured and recorded immediately and 1 hour later. The occurrence of pulmonary edema on initial chest X-ray at 6 hours, occurrence of tremor within 48 hours, ventricular fibrillation recurring within 48 hours, and consciousness or death within 14 days were recorded. RESULTS A total of 45 patients were enrolled, including 23 patients in icy normal saline group and 22 in control group. The patients in icy normal saline group had a rectal temperature descended from (36.7 ± 0.9) centigrade to (34.9 ± 0.7) centigrade 1 hour later, while the patients in control group had a rectal temperature risen from (36.5 ± 1.0) centigrade to (37.9 ± 0.9) centigrade 1 hour later. There was significant difference in rectal temperature between two groups (t=2.228, P=0.031). The number of patients who successfully awaken within 14 days in ice normal saline group was significantly larger than that in control group (13 cases vs. 7 cases, χ² = 65.710, P=0.021). There was no statistical difference in the occurrence of acute pulmonary edema (4 cases vs. 6 cases), tremor (2 cases vs. 0 case), ventricular fibrillation recurrence (4 cases vs. 5 cases) and death within 14 days(11 cases vs. 12 cases, all P>0.05). CONCLUSIONS The study shows that early rapid i.v. infusion of 4 centigrade normal saline is feasible, safe and effective for cerebral resuscitation.
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Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline.
Kim, F, Olsufka, M, Longstreth, WT, Maynard, C, Carlbom, D, Deem, S, Kudenchuk, P, Copass, MK, Cobb, LA
Circulation. 2007;(24):3064-70
Abstract
BACKGROUND Although delayed hospital cooling has been demonstrated to improve outcome after cardiac arrest, in-field cooling started immediately after the return of spontaneous circulation may be more beneficial. The aims of the present pilot study were to assess the feasibility, safety, and effectiveness of in-field cooling. METHODS AND RESULTS We determined the effect on esophageal temperature, before hospital arrival, of infusing up to 2 L of 4 degrees C normal saline as soon as possible after resuscitation from out-of-hospital cardiac arrest. A total of 125 such patients were randomized to receive standard care with or without intravenous cooling. Of the 63 patients randomized to cooling, 49 (78%) received an infusion of 500 to 2000 mL of 4 degrees C normal saline before hospital arrival. These 63 patients experienced a mean temperature decrease of 1.24+/-1 degrees C with a hospital arrival temperature of 34.7 degrees C, whereas the 62 patients not randomized to cooling experienced a mean temperature increase of 0.10+/-0.94 degrees C (P<0.0001) with a hospital arrival temperature of 35.7 degrees C. In-field cooling was not associated with adverse consequences in terms of blood pressure, heart rate, arterial oxygenation, evidence for pulmonary edema on initial chest x-ray, or rearrest. Secondary end points of awakening and discharged alive from hospital trended toward improvement in ventricular fibrillation patients randomized to in-field cooling. CONCLUSIONS These pilot data suggest that infusion of up to 2 L of 4 degrees C normal saline in the field is feasible, safe, and effective in lowering temperature. We propose that the effect of this cooling method on neurological outcome after cardiac arrest be studied in larger numbers of patients, especially those whose initial rhythm is ventricular fibrillation.
4.
Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival.
Vukmir, RB, ,
Emergency medicine journal : EMJ. 2004;(3):370-3
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Abstract
INTRODUCTION This study correlated the effect of witnessing a cardiac arrest and instituting bystander CPR (ByCPR), as a secondary end point in a study evaluating the effect of bicarbonate on survival. METHODS This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on emergency department (ED) arrival. Data were analysed using chi(2) with Pearson correlation and odds ratio where appropriate. RESULTS The overall survival rate was 13.9% (110 of 792) of prehospital cardiac arrest patients. The mean (SD) time until provision of bystander cardiopulmonary resuscitation (ByCPR) by laymen was 2.08 (2.77) minutes, and basic life support (BLS) by emergency medical technicians was 6.62 (5.73) minutes. There was improved survival noted with witnessed cardiac arrest-a 2.2-fold increase in survival, 18.9% (76 of 402) versus 8.6% (27 of 315) compared with unwitnessed arrests (p<0.001) with a decreased risk ratio of mortality of 0.4534 (95% CI, 0.0857 to 0.1891). The presence of ByCPR occurred in 32% (228 of 716) of patients, but interestingly did not correlate with survival. The survival rate was 18.2% (33 of 181) if ByCPR was performed within two minutes and 12.8% (6 of 47), if performed >two minutes (p = 0.3752). CONCLUSIONS Survival after prehospital cardiac arrest is more likely when witnessed, but not necessarily when ByCPR was performed by laymen.