Epidemiology, outcomes and coronary angiography findings of patients following out-of-hospital cardiac arrest

Objectives: Out-of-hospital cardiac arrests [OHCAs] are a leading cause of death worldwide. However, data regarding the management and outcomes of affected patients are lacking in the Middle East. The current study aimed to present the angiographic findings and outcomes of patients presenting with OHCA in Muscat, Oman

Methods: This retrospective study took place between January 2012 and December 2016 at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman. All adult patients who presented following an OHCA to the Emergency Department of SQUH during the study period were included. Demographic and clinical data were collected from electronic medical records

Results: A total of 216 patients were included in the study. The majority [63.9%] presented after having collapsed, while 22.3% presented with chest pains. Asystole was the most frequent initial cardiac rhythm [62.5%], with only 10% having ventricular tachycardia/fibrillation. Very few patients [1.4%] had received cardiopulmonary resuscitation [CPR] prior to presentation. In total, 85 patients [39.4%] returned to spontaneous circulation [RSC]; of these, post RSC electrocardiography revealed an ST-segment elevation in 41.2% and normal findings in 23.5%. There were 63 patients who underwent coronary angiography, with 28 requiring stenting. Overall, 13% of patients survived and were discharged, although three survivors suffered permanent hypoxic brain damage

Conclusion: The overall survival rate of patients who had experienced an OHCA was low. Education programmes should focus on the benefits of immediate CPR for individuals experiencing an OHCA, with more opportunities for CPR training to be made available to the general public in Oman

Procedural and clinical utility of transulnar approach for coronary procedures following failure of radial route: Single centre experience

Objectives: To assess the feasibility and safety of transulnar approach whenever transradial access fails

Background: Radial access for coronary procedures has gained sound recognition. However, the method is not always successful

Methods: Between January 2010 and June 2013, diagnostic with or without percutaneous coronary intervention [PCI] was attempted in 2804 patients via the radial approach. Transradial approach was unsuccessful in 173 patients [6.2%] requiring crossover to either femoral [128 patients, 4.6%] or ulnar approach [45 patients, 1.6%]

Patients who had undergone ulnar approach constituted our study population. Selective forearm angiography was performed after ulnar sheath placement

We documented procedural characteristics and major adverse cardio-cerebrovascular events

Results: Radial artery spasm was the most common cause of crossover to the ulnar approach [64.4%] followed by failure to puncture the radial artery [33.4%]

Out of 45 patients [82.2%], 37 underwent successful ulnar approach

The eight failed cases [17.8%] were mainly due to absent or weak ulnar pulse [75%]. PCI was performed in 17 cases [37.8%], of which 8 patients underwent emergency interventions

Complications included transient numbness, non-significant hematoma, ulnar artery perforation, and minor stroke in 15.5%, 13.3%, 2.2% and 2.2%, respectively

No major cardiac-cerebrovascular events or hand ischemia were noted

Conclusion: Ulnar approach for coronary diagnostic or intervention procedures is a feasible alternative whenever radial route fails. It circumvents crossover to the femoral approach

Our study confirms satisfactory success rate of ulnar access in the presence of adequate ulnar pulse intensity and within acceptable rates of complications

Oral propranolol for the treatment of periorbital infantile hemangioma: a preliminary report from Oman

To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects. Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated. Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy. Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy