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1.
Am J Emerg Med ; 50: 14-21, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34265731

ABSTRACT

BACKGROUND: Knowing the kinetics of endogenous stress hormones during cardiac arrest and cardiopulmonary resuscitation (CRP) will help to optimize personalized physiology-guided treatment. The aim of this study was to examine the dynamic changes in stress hormones in a swine model of ventricular fibrillation (VF) cardiac arrest. METHODS: Ventricular fibrillation was induced in 10 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 min. All animals were resuscitated according to the 2015 European Resuscitation Council guidelines. The concentration of adrenalin, noradrenalin, and cortisol was measured at baseline and at the 4th and 8th minute of VF-cardiac arrest, as well as at 30-min, 60-min, 24 h and 48 h post-ROSC. RESULTS: By the end of the 4th min of VF, the animals of the ROSC group exhibited significantly higher adrenaline levels compared to those of the no-ROSC group (7264 pg/ml vs. 1648 pg/ml, p = 0.03). Noradrenaline was higher in the ROSC group at the 4th min of VF (3021 pg/ml vs. 1626 pg/ml, p = 0.02). Cortisol levels in the ROSC group were significantly lower by the end of the 8th min of VF [16.25 ng/ml vs. 92.82 ng/ml, p = 0.03]. With a cut-off point of 5970 pg/ml, adrenaline at the 4th min of VF exhibited 100% sensitivity and 80% specificity for predicting ROSC. CONCLUSION: Higher endogenous adrenaline and lower endogenous cortisol levels were associated with ROSC.


Subject(s)
Epinephrine/pharmacokinetics , Heart Arrest/metabolism , Hydrocortisone/pharmacokinetics , Norepinephrine/pharmacokinetics , Ventricular Fibrillation/metabolism , Animals , Cardiopulmonary Resuscitation , Disease Models, Animal , Heart Arrest/therapy , Male , Prospective Studies , Swine , Ventricular Fibrillation/therapy
2.
Biomed Res Int ; 2016: 3567275, 2016.
Article in English | MEDLINE | ID: mdl-27847811

ABSTRACT

Purpose. To investigate the effect of EPO administration on postresuscitation renal function. Methods. Twenty-four female Landrace/Large-White piglets aged 10-15 weeks with average weight of 19 ± 2 kg were randomly assigned to 2 different groups of 12 subjects each. After the end of an 8-minute ventricular fibrillation, the control group (Group C) received saline as placebo, whereas the EPO group (Group E) received EPO 5000 U/kg. The animals were resuscitated according to the 2010 European Resuscitation Council Guidelines for Resuscitation. Results. Five animals (41.67%) from Group C and 11 animals (91.67%) from Group E achieved ROSC (p = 0.027). Eight animals (66.67%, 5 surviving and 3 nonsurviving) from Group C suffered severe kidney damage or AKI compared to animals from Group E, in which none of the swine had evidence of severe kidney damage or AKI (p = 0.001). There was a statistically significant difference in all tested biochemical markers between the two groups, as well as a positive correlation of creatinine with NGAL, L-FABP, and IL-18 (summed mean values' p = 0.049, 0.01, and 0.004, resp.). Conclusions. Administration of EPO protected swine from postresuscitation acute kidney injury.


Subject(s)
Acute Kidney Injury , Erythropoietin/pharmacology , Kidney/physiopathology , Resuscitation/adverse effects , Ventricular Fibrillation/therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Acute Kidney Injury/prevention & control , Animals , Female , Kidney/pathology , Swine
3.
Biomed Res Int ; 2016: 7261960, 2016.
Article in English | MEDLINE | ID: mdl-27504455

ABSTRACT

Aim. To evaluate the effects of erythropoietin administration on the adrenal glands in a swine model of ventricular fibrillation and resuscitation. Methods. Ventricular fibrillation was induced via pacing wire forwarded into the right ventricle in 20 female Landrace/Large White pigs, allocated into 2 groups: experimental group treated with bolus dose of erythropoietin (EPO) and control group which received normal saline. Cardiopulmonary resuscitation (CPR) was performed immediately after drug administration as per the 2010 European Resuscitation Council (ERC) guidelines for Advanced Life Support (ALS) until return of spontaneous circulation (ROSC) or death. Animals who achieved ROSC were monitored, mechanically ventilated, extubated, observed, and euthanized. At necroscopy, adrenal glands samples were formalin-fixed, paraffin-embedded, and routinely processed. Sections were stained with hematoxylin-eosin. Results. Oedema and apoptosis were the most frequent histological changes and were detected in all animals in the adrenal cortex and in the medulla. Mild and focal endothelial lesions were also detected. A marked interindividual variability in the degree of the intensity of apoptosis and oedema at cortical and medullary level was observed within groups. Comparing the two groups, higher levels of pathological changes were detected in the control group. No significant difference between the two groups was observed regarding the endothelial changes. Conclusions. In animals exposed to ventricular fibrillation, EPO treatment has protective effects on the adrenal gland.


Subject(s)
Adrenal Glands/drug effects , Erythropoietin/administration & dosage , Ventricular Fibrillation/drug therapy , Adrenal Cortex/drug effects , Adrenal Medulla/drug effects , Animals , Apoptosis/drug effects , Cardiopulmonary Resuscitation/methods , Disease Models, Animal , Female , Protective Agents/administration & dosage , Swine
4.
Pneumonol Alergol Pol ; 84(4): 205-11, 2016.
Article in English | MEDLINE | ID: mdl-27435346

ABSTRACT

INTRODUCTION: Recent developments in treatment have steadily raised the median predicted age of survival for people with Cystic Fibrosis (CF). We report the health-related quality of life (HRQoL) in CF adult patients and correlate our findings with the patients' demographic characteristics. MATERIAL AND METHODS: The Cystic Fibrosis Quality of Life (CFQoL) questionnaire was answered by 77 CF adult patients. The questionnaire included questions pertaining to age, sex and level of education and covered eight sections of functioning. RESULTS: The highest score was reported in the "Social Functioning" section, while the lowest in the "Concerns for the Future" section. When different age groups were compared, statistical significances were reported in "Physical Functioning", "Interpersonal Relationships", and the "Career Concerns" section, with older patients reporting statistically higher HRQoL scores than younger ones (p < 0.005). No statistically significant difference was reported amongst the scoring between male and female CF patients. When different educational levels were compared, patients that had received a higher educational training scored statistically higher in all but one sections of the questionnaire when compared with patients of a lower educational level (p < 0.005). CONCLUSION: More than half Greek adult CF patients report that they are capable to participate in social activities but most of them are worried about the outcome of their disease and its effect on their lives.


Subject(s)
Cystic Fibrosis/psychology , Quality of Life , Adolescent , Adult , Anxiety , Educational Status , Female , Greece/epidemiology , Health Status , Humans , Male , Middle Aged , Severity of Illness Index , Sex Factors , Surveys and Questionnaires , Young Adult
5.
Eur J Emerg Med ; 23(1): 56-60, 2016 Feb.
Article in English | MEDLINE | ID: mdl-25222425

ABSTRACT

OBJECTIVE: The European Paediatric Life Support (EPLS) provider course aims at training doctors and nurses in the efficient and prompt management of cardiopulmonary arrest in children. EPLS is a 2-day European Resuscitation Council course, involving the teaching of theoretical knowledge and practical skills. The aim of the study was to evaluate the retention of theoretical knowledge and certain skills of EPLS providers 4 months after the course. MATERIALS AND METHODS: In total, 80 doctors and nurses who attended three EPLS provider courses, from May 2012 to December 2012, were asked to participate in the study and only 50 responded positively. Demographic data (age, sex, occupation) of the participants were collected. The European Resuscitation Council-approved EPLS written test was used to assess theoretical knowledge right after the course and after 4 months. The retention of certain skills (airway opening, bag-mask ventilation, chest compressions) was also examined. RESULTS: The theoretical knowledge decreased significantly (P<0.001) 4 months after the course. Age, sex and occupational status (medical or nursing profession) had no effect in theoretical knowledge retention. Interestingly, certain skills such as the application of airway opening manoeuvres and effective bag-mask ventilation were retained 4 months after the course, whereas chest compression skill retention significantly declined (P=0.012). CONCLUSION: According to our findings, theoretical knowledge of the EPLS course uniformly declines, irrespective of the provider characteristics, whereas retention of certain skills is evident 4 months after the course.


Subject(s)
Cardiopulmonary Resuscitation/education , Clinical Competence , Life Support Care/methods , Pediatrics/education , Retention, Psychology/physiology , Adult , Educational Measurement , Emergency Medical Services/methods , Female , Greece , Humans , Male , Out-of-Hospital Cardiac Arrest/therapy , Risk Assessment , Time Factors
6.
Am J Emerg Med ; 32(8): 871-7, 2014 Aug.
Article in English | MEDLINE | ID: mdl-24857249

ABSTRACT

BACKGROUND: In addition to its role in the endogenous control of erythropoiesis, recombinant human erythropoietin (rh-EPO) has been shown to exert tissue protective properties in various experimental models. However, its role in the cardiac arrest (CA) setting has not yet been adequately investigated. AIM: The aim of this study is to examine the effect of rh-EPO in a pig model of ventricular fibrillation (VF)-induced CA. METHODS: Ventricular fibrillation was electrically induced in 20 piglets and maintained untreated for 8 minutes before attempting resuscitation. Animals were randomized to receive rh-EPO (5000 IU/kg, erythropoietin [EPO] group, n = 10) immediately before the initiation of chest compressions or to receive 0.9% Sodium chloride solution instead (control group, n = 10). RESULTS: Compared with the control, the EPO group had higher rates of return of spontaneous circulation (ROSC) (100% vs 60%, P = .011) and higher 48-hour survival (100% vs 40%, P = .001). Diastolic aortic pressure and coronary perfusion pressure during cardiopulmonary resuscitation were significantly higher in the EPO group compared with the control group. Erythropoietin-treated animals required fewer number of shocks in comparison with animals that received normal saline (P = .04). Furthermore, the neurologic alertness score was higher in the EPO group compared with that of the control group at 24 (P = .004) and 48 hours (P = .021). CONCLUSION: Administration of rh-EPO in a pig model of VF-induced CA just before reperfusion facilitates ROSC and improves survival rates as well as hemodynamic variables.


Subject(s)
Blood Circulation/drug effects , Erythropoietin/therapeutic use , Heart Arrest/drug therapy , Animals , Blood Pressure/drug effects , Cardiopulmonary Resuscitation , Disease Models, Animal , Female , Heart Arrest/etiology , Swine , Treatment Outcome , Ventricular Fibrillation/complications
7.
J Matern Fetal Neonatal Med ; 25(Suppl 5): 44-6, 2012 Oct.
Article in English | MEDLINE | ID: mdl-23025767

ABSTRACT

AIM: It was not until the 18th century that scientists throughout Europe established humane societies to develop resuscitation techniques and to keep registries of successful and unsuccessful cases. Since then, the science and art of cardiopulmonary resuscitation have flourished, multiple international organizations were found, and guidelines are proposed every 5 years in an everlasting attempt to improve the outcome of cardiac arrest victims. The aim of this article is to present the role of animal models in resuscitation research. METHODS: A comprehensive search in PubMed, CINAHL, Cochrane Library, and Scopus databases was performed. RESULTS: Mice, rats, and swine have been established as experimental models for conducting resuscitation research. The choice of the animal model is not a simple task, as there are multiple parameters that have to be considered when designing an experiment. CONCLUSION: Animal models are used extensively in resuscitation research and possess a central role in the effort towards a better understanding of the underlying mechanisms. However, experimental results should always be cautiously extrapolated in humans.


Subject(s)
Biomedical Research , Models, Animal , Resuscitation/methods , Adult , Animals , Cardiopulmonary Resuscitation/methods , Heart Arrest/mortality , Heart Arrest/therapy , Humans , Infant, Newborn , Mice , Pediatrics , Prognosis , Rats , Swine
8.
Heart Lung ; 40(4): 278-84, 2011.
Article in English | MEDLINE | ID: mdl-21724040

ABSTRACT

OBJECTIVE: The study objective was to determine cardiologists' theoretic knowledge of the 2005 American Heart Association (AHA) resuscitation guidelines. METHODS: The questionnaire consisted of demographic questions, resuscitation experience questions, a question regarding confidence in resuscitation skills, and 20 theoretic knowledge questions. RESULTS: For the theoretic knowledge questions, the participants' overall mean score was 9.9 ± 4.6 (range 3-20). Participants who had received advanced cardiac life support (ACLS) training scored significantly higher. Furthermore, those who had attended the ACLS course in the preceding year scored significantly higher compared with those who had attended the ACLS course more than 1 year before the survey (19.1 ± .6 vs 16.7 ± .67, P = .001). Theoretic knowledge of resuscitation did not increase with seniority. Furthermore, no correlation was observed between the theoretic knowledge scores and participants' self-appraisal of resuscitation knowledge. CONCLUSION: Cardiologists have knowledge gaps in the 2005 AHA resuscitation guidelines. Resuscitation knowledge decay 1 year after the course is evident.


Subject(s)
American Heart Association , Cardiology , Cardiopulmonary Resuscitation/instrumentation , Clinical Competence/statistics & numerical data , Heart Arrest/therapy , Practice Guidelines as Topic , Adult , Cardiopulmonary Resuscitation/methods , Chi-Square Distribution , Educational Measurement , Educational Status , Female , Greece , Humans , Male , Middle Aged , Pilot Projects , Surveys and Questionnaires , United States
9.
J Adv Nurs ; 66(7): 1469-77, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20492020

ABSTRACT

AIM: This paper identifies the characteristics of Greek patients with acute myocardial infarction who have long prehospital delays and identifies the factors that are specifically associated with these delays. BACKGROUND: The time between the first appearance of symptoms until the hospitalization of the patient with myocardial infarction correlates statistically significantly with in-hospital and long-term mortality. METHODS: The study took place in two Greek coronary care units from 1 June 2007 to 31 July 2008. From 232 consecutive patients with myocardial infarction, 160 were enrolled. Data were collected by a trained hospital staff nurse, who interviewed all patients within 48 hours of hospital admission. RESULTS: Smokers arrived statistically significantly sooner at the hospital than non-smokers [smokers' prehospital time delay: 78.9 (sd = 3.2) minutes vs. non-smokers' prehospital time delay: 98.2 (sd = 4.1) minutes, Mann-Whitney U-test, Z = -2.5, P < 0.05]. Patients with hyperlipidaemia arrived with a mean delay of 13 minutes less than normolipidaemic patients. Those with inferior ST segment elevation myocardial infarction exhibited statistically significantly shorter delay times than those with anterior or lateral (inferior vs. anterior, P = 0.003, inferior vs. lateral, P = 0.024, anova with Bonferroni-Holm post hoc test, F = 7.5, P = 0.001). CONCLUSION: Community nurses should educate all patients about myocardial infarction, not only those at high risk but also those without known risk factors for ischaemic heart disease.


Subject(s)
Myocardial Infarction/therapy , Patient Acceptance of Health Care/statistics & numerical data , Acute Disease , Aged , Cardiology Service, Hospital , Community Health Nursing/methods , Cross-Sectional Studies , Emergency Service, Hospital , Female , Greece , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Hyperlipidemias/epidemiology , Male , Middle Aged , Myocardial Infarction/mortality , Patient Education as Topic , Risk Factors , Smoking/epidemiology , Time Factors
10.
Resuscitation ; 81(3): 348-52, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20074843

ABSTRACT

AIM: The present study aims to investigate whether the distribution of the Basic Life Support and Automated External Defibrillation (BLS/AED) manual, 4 weeks prior to the course, has an effect on skill acquisition, theoretical knowledge and skill retention, compared with courses where manuals were not distributed. METHODS: A total of 303 laypeople were included in the present study. The courses were randomised with sealed envelopes in 12 courses, where manuals were distributed to participants (group A) and in 12 courses, where manuals were not distributed to participants (group B). The participants were formally evaluated at the end of the course, and at 1, 3 and 6 months after each course. The evaluation procedure was the same at all time intervals and consisted of two distinct parts: a written test and a simulated cardiac arrest scenario. RESULTS: No significant difference was observed between the two groups in skill acquisition at the time of initial training. Furthermore, there was no significant difference between the groups in performing BLS/AED skills at 1, 3 and 6 months after initial training. Theoretical knowledge in either group at the specified time intervals did not exhibit any significant difference. Significant deterioration of skills was observed in both groups between initial training and at 1 month after the course, as well as between the first and third month after the course. CONCLUSION: The present study shows that distribution of BLS/AED manuals 1 month prior to the course has no effect on theoretical knowledge, skill acquisition and skill retention in laypeople.


Subject(s)
Defibrillators , Learning , Life Support Systems , Manuals as Topic , Retention, Psychology , Adolescent , Adult , Aged , Educational Measurement/methods , Female , Heart Arrest/therapy , Humans , Male , Manikins , Middle Aged , Time Factors , Ventricular Fibrillation/therapy , Young Adult
11.
Nurse Educ Today ; 29(2): 224-31, 2009 Feb.
Article in English | MEDLINE | ID: mdl-18829143

ABSTRACT

BACKGROUND: Cardiac arrest (CA) is a leading cause of death worldwide. The European Resuscitation Council (ERC) has developed basic life support/automated external defibrillation (BLS/AED) courses for uniform training in out-of-hospital CA. OBJECTIVE: The present study compares the resuscitation skills of two groups of nursing staff, one taught by newly trained ERC nurse-instructors and the other by newly trained doctor-instructors. METHOD: Eighteen doctors and 18 nurses were asked to teach a total of 108 nurses in a (BLS/AED) course. One month after its completion, all 108 nurses were asked to be re-evaluated, with the use of the objective structured clinical examination. CONCLUSIONS: No statistical significant difference between the two groups was noted in the written test, in contrast with data collected from the practice skills check-list. Nurses in group A could easily identify the patient in cardiac arrest but had difficulties concerning chest compressions and handling the AED. Nurses in group B were more focused during the performances, used AED more accurately and continued cardiopulmonary resuscitation with no delays. Nurses prove to be more efficient in training nurses.


Subject(s)
Electric Countershock , Inservice Training/methods , Nursing Staff, Hospital/education , Resuscitation/education , Teaching , Cardiopulmonary Resuscitation/education , Greece , Humans , Nurses , Physicians
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