Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial.

We aimed to compare systemic and cerebral hemodynamics and coughing during emergence after pituitary surgery after endotracheal tube (ETT) extubation or after replacing ETT with a laryngeal mask airway (LMA). Patients were randomized to awaken with an ETT in place or after replacing it with an LMA. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO2), cardiac index, plasma norepinephrine, need for vasoactive drugs, coughing during emergence, and postoperative cerebrospinal fluid (CSF) leakage. The primary endpoint was postoperative MAP; secondary endpoints were SrO2 and coughing incidence. Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. There were no significant between-group differences in blood pressure, nor in the number of patients that required antihypertensive drugs during emergence (ETT: 8 patients (34.8%) vs. LMA: 3 patients (14.3%); p = 0.116). MCA flow velocity was higher in the ETT group (e.g., mean (95% CI) at 15 min, 103.2 (96.3-110.1) vs. 89.6 (82.6-96.5) cm·s-1; p = 0.003). SrO2, cardiac index, and norepinephrine levels were similar. Coughing was more frequent in the ETT group (81% vs. 15%; p < 0.001). CSF leakage occurred in three patients (13%) in the ETT group. Placing an LMA before removing an ETT during emergence after pituitary surgery favors a safer cerebral hemodynamic profile and reduces coughing. This strategy may lower the risk for CSF leakage.

Factores pronósticos en las paradas cardiorrespiratorias intrahospitalarias. Revisión de 760 casos / Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases

Fundamento y objetivo: Analizar las paradas cardiorrespiratorias (PCR) intrahospitalarias acontecidas en las salas de hospitalización convencional y evaluar los factores pronósticos de las mismas. Pacientes y método: Revisión retrospectiva de las PCR intrahospitalarias acontecidas en nuestro hospital durante un período de 9 años. Fueron excluidas las PCR en áreas de intensivos, quirófanos y urgencias. Datos recogidos: características demográficas, etiología y ritmo inicial de la PCR, datos de control interno, horario, lugar, métodos y resultados tras la reanimación cardiopulmonar (RCP) (recuperación de la circulación espontánea [RCE] y supervivencia al alta hospitalaria [SAH]) y estado neurológico al alta. Los resultados se analizaron con el paquete estadístico SPSS® v. 20. Resultados: Edad media 66,9 ± 17,5 años; 63,5% hombres. Tiempo medio de llegada del equipo de PCR = 1,75 ± 0,74 min, con una duración media de RCP = 25,8 ± 16,10 min. Ritmo inicial: a) desfibrilable = 22,1%; b) asistolia = 66,2%, y c) actividad eléctrica sin pulso = 11,7%. RCE = 51% y SAH = 24,8%. Factores asociados a un mejor pronóstico (p < 0,05): edad, motivo de ingreso hospitalario, estado previo del paciente, etiología y mecanismo principal de la PCR, número de desfibrilaciones y duración media de la RCP. Conclusiones: A pesar de haber estudiado diversas variables como factores pronósticos de la RCP y haber obtenido significación estadística en alguna de ellas, la predicción precoz de la supervivencia ante una PCR intrahospitalaria sigue siendo incierta. En cualquier caso, nuestro estudio evidencia que mediante una aplicación racional de medidas organizativas, el 25% de las PCR intrahospitalarias podrían llegar a ser dadas de alta en buenas condiciones, por lo que deberían generalizarse planteamientos organizativos y docentes similares en los grandes hospitales (AU)

Background and objective: The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. Patients and method: Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS® v. 20 predictive analytics software. Results: Average age was 66.9 ± 17.5 years; 63.5% male. CA team arrived in 1.75 ± 0.74 min on average, and the average length of CPR was 25.8 ± 16.10 min. First rhythm: a) shockable rhythms = 22.1%; b) asystole = 66.2%, and c) pulseless electrical activity = 11.7%. ROSC = 51% and SAD = 24.8%. Factors associated with a better prognostic (P < .05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. Conclusions: Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals (AU)

[Prognostic factors for in-hospital cardiopulmonary arrests. A review of 760 cases]. / Factores pronósticos en las paradas cardiorrespiratorias intrahospitalarias. Revisión de 760 casos.

BACKGROUND AND OBJECTIVE: The aim of this study is to analyse in-hospital cardiopulmonary arrests (CA) that took place in conventional wards and evaluate their prognostic factors. PATIENTS AND METHOD: Retrospective review of in-hospital CA which occurred in our hospital over a 9-year period. CA that took place in intensive care areas, emergency rooms and operating theatres were excluded from the study. The following data were collected: demographic data, cause and initial rhythm of CA, internal control data, time, place, methods and results after cardiopulmonary resuscitation (CPR) (recovery of spontaneous circulation, [ROSC], and survival at discharge [SAD]) and neurologic performance at discharge. Results were analysed with SPSS(®) v. 20 predictive analytics software. RESULTS: Average age was 66.9±17.5 years; 63.5% male. CA team arrived in 1.75±0.74min on average, and the average length of CPR was 25.8±16.10min. First rhythm: a) shockable rhythms=22.1%; b) asystole=66.2%, and c) pulseless electrical activity=11.7%. ROSC=51% and SAD=24.8%. Factors associated with a better prognostic (P<.05): age, reason for hospital admission, patient's previous physical condition, principal cause of CA, number of defibrillations and average length of CPR. CONCLUSIONS: Despite having studied several variables as prognostic factors for CA and some of them being statistically significant, early prediction for survival for an in-hospital CA remains uncertain. Our study suggests that applying rational organisational measures, 25% of in-hospital CA could be discharged from hospital in good condition, and therefore, these organisational and educational measures should be extended to large hospitals.

Mechanical thrombectomy in acute basilar artery occlusion: A safety and efficacy single centre study.

OBJECTIVES: The objective of this study was to add more evidence about the efficacy and safety of mechanical thrombectomy in patients with basilar artery occlusion and secondarily to identify prognostic factors. METHODS: Twenty-two consecutive patients (mean age 60.5 years, 15 men) with basilar artery occlusion treated with mechanical thrombectomy were included. Clinical, procedure and radiological data were collected. Primary outcomes were the modified Rankin scale score with a good outcome defined by a modified Rankin scale score of 0-2 and mortality rate at three months. RESULTS: The median National Institutes of Health stroke scale at admission was 24 (interquartile range 11.5-31.25). Twelve patients (54.5%) required tracheal intubation due to a decreased level of consciousness. Successful recanalisation (modified treatment in cerebral ischaemia scale 2b-3) was achieved in 20 patients (90.9%). A favourable clinical outcome (modified Rankin scale score 0-2) was observed in nine patients (40.9%) and the overall mortality rate was 40.9% (nine patients). Haemorrhagic events were observed in three patients (13.63%). A decreased level of consciousness requiring intubation in the acute setting was more frequent in patients with poor outcomes (84.6%) than in patients with favourable outcomes (11.1%), and in patients who died (100%) compared with those who survived (23.1%), with a statistically significant difference (P = 0.002 and P = 0.001, respectively). CONCLUSION: Mechanical thrombectomy is feasible and effective in patients with acute basilar artery occlusion. A decreased level of consciousness requiring tracheal intubation seems to be a prognostic factor and is associated with a poor clinical outcome and higher mortality rate. These initial results must be confirmed by further prospective studies with a larger number of patients.

Use of therapeutic hypothermia and extracorporeal life support after an unusual response to the ajmaline challenge in a patient with Brugada syndrome.

BACKGROUND: Brugada syndrome is a cardiac disorder associated with a high risk of sudden cardiac death, especially in young subjects. The incidence and prevalence are likely underestimated. The diagnosis is based on a characteristic electrocardiography (ECG) pattern. The most commonly performed confirmatory test in cases of equivocal ECG is the intravenous ajmaline challenge. Although relatively safe, it carries the risk of ventricular arrhythmias that could potentially degenerate into a refractory electrical storm. CASE REPORT: A 27-year-old man developed sustained ventricular fibrillation after ajmaline challenge. He was rescued on extracorporeal life support after 108 min of cardiopulmonary resuscitation. Extracorporeal life support allowed recovery of spontaneous circulation and resulted in a positive neurological outcome..

Viabilidad de los donantes a corazón parado y capnografía / Feasibility of donors-after-cardiac-death and capnography

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Monitoring in resuscitation: comparison of cardiac output measurement between pulmonary artery catheter and NICO.

AIM: The cardiac output and coronary perfusion pressure generated from chest compressions during resuscitation manoeuvres can predict effectiveness and successful outcome. Until now, there is no good method for haemodynamic monitoring during resuscitation. Noninvasive partial carbon dioxide rebreathing system (NICO, Novametrix Medical Systems, Inc., Wallingford, CT, USA) is a relatively new non-invasive alternative to thermodilution for measuring cardiac output. The accuracy of the NICO system has not been evaluated during resuscitation. The aim of this study is to compare thermodilution cardiac output method with NICO system and to assess the utility of NICO during resuscitation. METHODS AND DESIGN: Experimental study in 24 Yorkshire pigs. Paired measurements of cardiac output were determined during resuscitation (before ventricular fibrillation and after 5, 15, 30 and 45 min of resuscitation) in the supine position. The average of 3 consecutive thermodilution cardiac output measurements (10 ml 20 degrees C saline) was compared with the corresponding NICO measurement. RESULTS: Bland and Altman plot and Lin's concordance coefficient showed a high correlation between NICO and thermodilution cardiac output measurements although NICO has a tendency to underestimate cardiac output when compared to thermodilution at normal values of cardiac output. CONCLUSIONS: There is a high degree of agreement between cardiac output measurements obtained with NICO and thermodilution cardiac output during resuscitation. The present study suggests that the NICO system may be useful to measure cardiac output generated during cardiopulmonary resuscitation.