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Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38e0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33e.0.88, p ¼ 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p 0.263). Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.
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Sudden cardiac arrest (SCA) remains a major healthcare issue worldwide with gloomy outcomes due to poor perfusion of cardiopulmonary resuscitation (CPR), deemed unsuitable for hemostatic conditions, cardiotorsal anatomy, electrophysiology, and thoracic biomechanics. Alternatively, we propose a new management, implementing rational exploitation of the stagnant blood masses: manually with a novel technique of cardiac massage and mechanically with a circulatory flow restoration (CFR) device. Methods: Simulated chest compressions were performed through the 5th intercostal space in professional Lifeguards volunteers, placed in the left lateral decubitus position with raised legs and abdominal compression. Results: Bypassing the sternal barrier, refilling the heart, and then compressing the chest with a recoil-rebound maneuver (3R / CPR) can significantly promote return of spontaneous circulation (ROSC). The effectiveness of the CFR device versus CPR has previously been demonstrated in the literature. Conclusion: Unlike current CPR, the 3R/CPR adapts human morphology and provides adequate myocardial perfusion promoting ROSC safely, under all circumstances. Preclinical computational models can confirm the effectiveness of the technique.
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Abstract Sudden cardiac arrest (SCA) and sudden death (SD) continue to be a global public health problem, although the true incidence is unknown, it is estimated that they are responsible for 30% of cardiac origin mortality and may represent 20% of total mortality in adults. Unfortunately, the majority of cases occur in the general population, at the out-of-hospital level, in homes and in people who were not known to have heart disease. Although the majority of SCA victims are considered to be of cardiac origin and more frequent ischemic, it is not possible to rule out other causes only with the clinical diagnosis. Autopsy, histological, and toxicological studies are necessary in all victims of SCA and SD to determine the precise cause of death; when these studies are carried out, causes of non-cardiac origin have been found in up to 40% of victims. The type of arrhythmia responsible for an episode of SCA and SD has changed over the years, now asystole and pulseless electrical activity are detected more frequently than ventricular fibrillation or pulseless ventricular tachycardia. These and other aspects that we consider important in the current behavior of SCA and SD are analyzed in this article.
Resumen El paro cardíaco súbito (PCS) y la muerte súbita (MS) continúan siendo un problema de salud pública mundial; aunque su verdadera incidencia se desconoce, se calcula que producen el 30% de la mortalidad de origen cardíaco y pueden representar el 20% de la mortalidad total en los adultos. Desafortunadamente, la mayor parte de los casos se presenta en la población general, de forma extrahospitalaria, en los hogares y en personas que no se conocían portadoras de cardiopatía. Aunque se considera que la mayoría de las víctimas de PCS es de origen cardíaco, y que es más frecuente el isquémico, no es posible descartar otras causas sólo con el diagnóstico clínico. Son necesarios la necropsia y los estudios histológicos y toxicológicos en todas las víctimas de PCS y MS para determinar la causa precisa de la muerte; cuando estos estudios se efectúan se han encontrado causas de origen no cardíaco hasta en 40% de las personas. El tipo de arritmia causante de un episodio de PCS y MS ha cambiado a través de los años; ahora se detectan con mayor frecuencia asistolia y actividad eléctrica sin pulso (AESP) que la fibrilación ventricular (FV) o la taquicardia ventricular sin pulso (TVSP). Estos y otros aspectos de importancia en el comportamiento actual del PCS y la MS se analizan en este artículo.
Subject(s)
Humans , Adult , Arrhythmias, Cardiac/complications , Global Health , Death, Sudden, Cardiac/epidemiology , Arrhythmias, Cardiac/epidemiology , Autopsy , Public Health , Incidence , Cause of Death , Death, Sudden, Cardiac/etiologyABSTRACT
Introduction: Colloid cysts are one of the benign intracranial tumors most commonly occurring in the rostral part of the thirdventricle. These may present with varied spectrum of clinical features that poses challenges in clinical diagnosis. The presentationmay range from being asymptomatic to simple headaches, seizures, and even sudden death. Most of the symptoms can beattributed to the development of obstructive hydrocephalus. Chemical or aseptic meningitis is unusual complication posingcomplicating differential diagnosis. We describe eight such cases with wide variety of symptoms.Materials and Methods: We present a case series of eight cases of the third ventricle colloid cysts presented at our institute.Age of the patients ranged from 15 to 55 and five of them were females. All the clinical features were recorded from eachone of them. Computed tomography and magnetic resonance imaging were used to diagnose the condition. Four of themunderwent excision of the cyst in single stage either by open or endoscopic approach. Two patients underwent preliminaryventriculoperitoneal shunt done in the view of poor neurological status and craniotomy and excision was done in later stage. Inone patient bedside external ventricular drain was inserted for emergency decompression of ventricles. One patient is underserial radiological follow-up.Results: Eight cases that we observed had wide variety of symptoms. Six patients had chronic headache with progressiveseverity, and four of them had nausea with vomiting, three patients had seizures. The cysts in two patients were discoveredaccidentally, during the evaluation of seizures in one patient and others in evaluation of traumatic head injury. One elderly patienthad presented with psychiatric symptoms, drop attacks along with the features of normal pressure hydrocephalus. One teenagepatient presented with sudden deterioration and went into cardiac arrest even after emergency decompression of ventriclesdone. Seven of them underwent surgery and one of them succumbed. The surgery improved health in all other seven patients.Conclusion: Colloid cysts may present with a wide range and beyond expected neurological manifestations. The severity orrapid clinical deterioration does not exactly correlate with depending on the site, size of the cyst. Leaking cysts with chemicalmeningitis may further complicate the diagnosis. Hence, early diagnosis and surgery with complete removal of cysts offer betterclinical outcomes in those patients.
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Background: In the event of sudden cardiac arrest, early intervention (within 3–5 min) and defibrillation increases survival rates. That is why it is important for all citizens to be able to recognize a cardiac emergency and administer first aid while the advanced life support arrives. Objectives: The objectives of this study were as follows: (1) To assess the knowledge on cardiopulmonary resuscitation (CPR) among degree students, (2) to conduct educational intervention regarding CPR measures, and (3) to conduct post-test to assess the knowledge and their performance on CPR after educational intervention. Materials and Methods: In a cross-sectional study, the study was conducted Silver Jubilee Degree College, B-camp, Kurnool city, Andhra Pradesh, India. The study was conducted at Silver Jubilee Degree College, Kurnool, Andhra Pradesh, India. The ethical clearance was taken from the institutional ethical committee. Informed consent of those who are willing to participate in the study was taken. The study was conducted from November 1, 2018, to December 31, 2018. A total of 200 degree students from 550 male students voluntarily attended the education and training session. Results: Of 200 study participants, on whom basic life support (BLS) program was conducted, a significant increase was noted before and after educational intervention regarding their knowledge on symptoms of heart attack, types of chest pain, knowledge on CPR, and performance on steps of CPR. Conclusions: As BLS is a lifesaving maneuver, it is essential for all citizens to know the basics and respond to emergency situations such as heart attack, drowning, and accidents. A significant change in attitude-behavior and awareness can be noted in students who underwent training and educational intervention.
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Background: Sudden cardiac death (SCD) is a leading cause of death in young athletes. Most of those events occur during exercise and insports facilities. We sought to assess awareness and attitudes towards automated external defibrillators (AED) in sports facilities in Jeddah,Saudi Arabia. Methods: The survey included 293 individuals who attend 18 different sports facilities in Jeddah, Saudi Arabia to estimatethe overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of sudden cardiacarrest (SCA). We included adult participants who were 18 years of age or older. After explaining the aim of our study, each participant wasconsented to participate in the survey. The survey included 33 questions to assess demographic characteristics, knowledge, and skills ofCPR, confidence to perform CPR and to use AED. Results: A total of 293 candidates completed the questionnaire. Mean age was 28.33 ±8.22 years. Only 19 candidates who worked in sports facilities agreed to participate in our survey, of those only 10 participants hadprevious CPR training but only 8 (42.1%) had the self-confidence to do CPR and use AED. Of individuals who participated in the survey,110 (37%) of them indicated that they were more likely to intervene in an SCA after receiving the proper training. 140 (47.7%) participantsof our cohort were reluctant to perform CPR because they were anxious about harming the arrested patient. 108 (36%) of our cohort couldexplain the purpose of using AED. Unfortunately, 101 (34.5%) of our sample did not know the number of Red Crescent for emergency calls.73 (53.7%) of the total 136 participants who received CPR training before stated that they are able to use AED. Our survey showed that264 (90.1%) wished to receive BLS training course if it was announced in order to qualify them for performing CPR and applying AED.Conclusion: Our survey showed insufficient knowledge in all aspects of CPR skills and inadequate knowledge of AED and its purpose ofuse in sports facilities in Jeddah. We recommend initiating an effective national public campaign to increase the public awareness of theimportance of CPR and AED performance using different pathways for education through media and new legislations.
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It is generally accepted that vigorous exercise may trigger cardiovascular accidents if underlying cardiovascular disease is present. Coronary artery disease is the most frequent cause of sudden cardiac arrest, especially in older individuals (> or = 35 years of age). We describe two patients who presented with cardiac arrest followed by loss of consciousness. Both had been participating in a marathon race. After acute myocardial infarction was diagnosed by electrocardiography and laboratory findings, urgent percutaneous coronary intervention was performed on both patients.
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Adult , Humans , Cardiovascular Diseases , Racial Groups , Coronary Artery Disease , Death, Sudden, Cardiac , Electrocardiography , Heart Arrest , Myocardial Infarction , Percutaneous Coronary Intervention , UnconsciousnessABSTRACT
Multivascular preventive and therapeutic approaches are necessary in patients with coronary artery disease because atherosclerosis has a common systemic pathogenesis. We present a rare case of sudden cardiac arrest with acute myocardial infarction induced by the total occlusion of left subclavian artery (LSCA) in a patient with a history of previous coronary artery bypass surgery using the left internal mammary artery. We initially performed blind-puncture of left brachial artery, attempting percutaneous coronary intervention because pulses were absent in both upper and lower extremities. However, the cause of sudden cardiac arrest was atherosclerotic total occlusion of LSCA. The patient was stabilized after successful revascularization of LSCA by percutaneous transluminal angioplasty with stent insertion.
Subject(s)
Humans , Angioplasty , Atherosclerosis , Brachial Artery , Coronary Artery Bypass , Coronary Artery Disease , Coronary Vessels , Death, Sudden, Cardiac , Lower Extremity , Mammary Arteries , Myocardial Infarction , Percutaneous Coronary Intervention , Stents , Subclavian ArteryABSTRACT
Patients with intermittent claudication secondary to spinal problem may have asymptomatic cardiac disease. We experienced a case of sudden cardiac arrest in a low-risk male patient during elective spinal surgery which was performed in accordance with the current guidelines. A 54-year-old male, who did not have active cardiac conditions or clinical risk factors for perioperative cardiovascular events, was scheduled to have a planned surgery for spinal stenosis without preoperative testing for cardiovascular events according to the current guidelines. But, he developed sudden cardiac arrest during elective spinal surgery. Emergent coronary angiogram showed significant stenosis in the distal left main coronary artery and proximal left anterior descending coronary artery. We successfully deployed 2 bare metal stents with intravascular ultrasound guidance. His mental state recovered and he was extubated 4 hours later. On day 8 in the hospital, he was transferred to the local hospital for care of his spinal problem.
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Humans , Male , Constriction, Pathologic , Coronary Vessels , Death, Sudden, Cardiac , Heart Diseases , Intermittent Claudication , Risk Factors , Spinal Stenosis , StentsABSTRACT
El cardiodesfibrilador implantable ha revolucionado la prevención y el tratamiento de la muerte súbita cardiaca. A pesar de ello subsisten dudas en cuanto a su indicación en diversas circunstancias de la práctica clínica diaria. Algunas respuestas para los principales interrogantes se describen a continuación: 1. de acuerdo a las estadísticas mundiales la incidencia anual de muerte súbita varía entre 750 y 1000 muertes súbitas cardiacas por millón de habitantes, y el 80% se relacionan con cardiopatía isquémica. 2. Mientras aproximadamente un cuarto de las muertes súbitas ocurren en sujetos con antecedentes severos de enfermedad cardiaca y deterioro de la función ventricular, en el 75% restante el episodio se desarrolla en individuos con escasos antecedentes o sin ellos y con funciones ventriculares normales. 3. En sujetos con antecedentes previos, el riesgo de desarrollar arritmias letales no decrece con el paso del tiempo, y puede desarrollarse muchos años después del episodio que marcó el inicio de la enfermedad. 4. La Terapia farmacológica puede actuar como co-adyudante para disminuir el riesgo arrítmico, pero no reemplaza la indicación del cardiodesfibrilador de acuerdo a las guías actuales. 5. El estudio electrofisiológico, no ha demostrado ser eficaz en la estratificación del riesgo de muerte súbita cardiaca. 6. En individuos con escasos antecedentes y sin deterioro de la función ventricular, y en la población general que consulta al cardiólogo, los antecedentes familiares de muerte súbita a temprana edad, y la observación de patrones electrocardiográficos específicos (onda delta, QT largo, etc.), pueden ser las únicas alertas que nos lleven a investigar un posible candidato a la muerte súbita. 7. A pesar de la descripción de choques inapropiados y de eventualmente daño miocárdico asociado a la terapia de choque, el cardiodesfibrilador continúa siendo la terapia de elección en la prevención y tratamiento de la muerte súbita arrítmica.
The implantable cardioverter defibrillator (ICD), has changed the view related to prevention and treatment of sudden cardiac arrest (SCA). However, some issues are still matter of discussion. Answers for the main questions are briefly exposed. 1. According to worldwide statistics, the annual incidence of SCA varies between 750 and 1000 people per million inhabitants. 2. Nearly 25% of SCA are related to individuals with severe heart disease and low ejection fraction, but in the remaining 75% there are scarce or no antecedents at all, plus normal left ventricular function. 3. In subjects with history of severe heart disease, the risk of SCA does not decrease along the time. 4. Pharmacological treatment did not prove to be safe for SCA prevention and cannot replace the ICD indication. 5. Except in particular cases, EP testing is not the right tool for risk stratification of SCA. 6. In the population with minor or without antecedents of heart disease, family history of SCA below 40 years old, or some features in the ECG (delta wave, long QT interval, etc), would be the unique sign of risk for developing SCA. 7. Although inappropriate shocks and eventually myocardial injury due to shock therapy may occur, the ICD still is the best therapy for prevention and treatment of SCA.
Subject(s)
Humans , Death, Sudden, Cardiac/prevention & control , Cardiology , Defibrillators, Implantable , Practice Guidelines as TopicABSTRACT
A 51-year-old female patient was referred to the emergency department with a 5-h history of resting chest pain. The patient, who had been diagnosed with variant angina six months previously, had not used her medications within two days of presentation. Electrocardiography (ECG) revealed a T wave inversion on lead I, AVL, and all precordial leads. Two hours later, the patient's chest pain was suddenly aggravated with an ST segment elevation noted from leads V2-6, leading to shock. Emergency management, including cardiopulmonary resuscitation (CPR), was initiated. Coronary angiography showed diffuse multifocal narrowing of three vessels; however, the vessels recovered following the intracoronary injection of nitroglycerin. The patient went into cardiac arrest two more times during continuous nitroglycerin infusion. The attacks were managed using CPR and sublingual nifedipine. Here, we describe a rare case of life-threatening three-vessel coronary vasospasm and its successful management with calcium channel blockers.
Subject(s)
Female , Humans , Middle Aged , Calcium Channel Blockers , Cardiopulmonary Resuscitation , Chest Pain , Coronary Angiography , Coronary Vasospasm , Coronary Vessels , Death, Sudden, Cardiac , Electrocardiography , Emergencies , Heart Arrest , Nifedipine , Nitroglycerin , Shock , SpasmABSTRACT
Objective To investigate the effects of 4 °C hypertonic saline (HTS) on S100 protein in serum and brain tissues of rats after cardiac arrest (SCA). Method Thirty SD male rats were randomly divided into shame-operated group (A), NS group (B) ,4℃ NS group (C), HTS group (D) and 4℃. HTS group (E), in e-qual number ( n = 6). Drugs were given to the rats of all groups at the initiation of CPR except group A. The rat model of CA was induced by asphyxia. Over 24 hours after restoration of spontanous circulation ( ROSC), venous blood sample was drawn to detcect the concentration of serum S100 protein in each group, and the rats were sacrificed and their brain tissues were taken for comparing the expressions of S100 protein in hippocampus. One-way analysis of variance and q -test were used for comparison among groups. P < 0.05 was considered significant. Results Compared with group A, the concentration of serum S100 protein in other groups were much higher ( P < 0.01). Compared with group B,the concentrations of serum S100 protein in groups C, D and E were also much lower ( P < 0.01). Compared with groups D and E, the concentration of serum S100 protein in group C was much higher ( P < 0.01). Compared with group D, the concentration of serum S100 protein in group D was higher ( P < 0.05). Compared with group A, the expressions of S100 protein in rats brain tissues of groups B,C and D were much higher ( P < 0.01). The expression of S100 protein in brain tissue of rats in group E was also higher than that in rats of group A ( P < 0.05). Compared with group B, the expressions of S100 protein in brain tissues of rats in groups C,D and E were lower (P < 0.05 and P < 0.01). Compared with group C, the expressions of S100 protein in brain tissues of rats in groups D and E were lower (P < 0.01). Compared with group D, the expression of S100 protein in brain tissue of rats in group E was lower (P < 0.05). Conclusions After CA the 4℃ HTS can decrease serum S100 protein level and inhibit the expression of S100 protein in hippocampus, then protecting the brain tissue.
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Automated external defibrillator(AED) is introduced including its practical functions,easy operation,and its role in the Public Access Defibrillation.The combination of AED with cardiopulmonary resuscitation is clarified,i.e.rescuers ought to perform early defibrillation toward the victim experiencing sudden cardiac arrest with shockable rhythm as rapidly as possible,and then turn to chest compressions without delay.At last,the existing situation and the shortcomings in the utilization of AED in China are pointed out along with its prospects.