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1.
J Cardiovasc Pharmacol ; 55(4): 391-8, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20147846

ABSTRACT

BACKGROUND: In Japan, intravenous nifekalant (NIF) was often used for direct current cardioversion-resistant ventricular fibrillation (VF), until the use of intravenous amiodarone (AMD) was approved in 2007. The defibrillatory efficacy of NIF and AMD has thus far not been compared for resuscitation. METHODS AND RESULTS: Between August 2007 and April 2009, 403 consecutive out-of-hospital patients with cardiopulmonary arrest were transferred to the Emergency Medical Service of Tokai University. Of these, 30 patients with first defibrillation failure or VF recurrence were enrolled for this NIF/AMD study. The final defibrillation success (and hospital survival rate) was 67% (10/15) in the AMD and 47% (7/15) in the NIF group. The discharge survival rate was 53% (8/15) in the AMD and 21% (4/15) in the NIF group (P = 0.06). Notably, all 4 survivors in the NIF group could take up normal daily life again, whereas this was restricted to only 2 patients from the 11 survivors in the AMD group. The difference is probably partly attributable to longer time from AMD administration to defibrillation success compared with NIF. In the cases of defibrillation failure, VF continued in 4/8 by NIF, however, asystole or pulseless electrical activity occurred in 4/5 patients by AMD. CONCLUSIONS: AMD may be borderline superior over NIF to facilitate defibrillation in out-of-hospital patients with cardiopulmonary arrest. However, from the view point of preservation of brain function, NIF is not inferior to AMD for CPR.


Subject(s)
Amiodarone/therapeutic use , Electric Countershock , Emergency Service, Hospital , Heart Arrest/drug therapy , Pyrimidinones/therapeutic use , Ventricular Fibrillation/drug therapy , Aged , Amiodarone/administration & dosage , Amiodarone/adverse effects , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/therapeutic use , Drug Therapy, Combination , Female , Heart Arrest/etiology , Heart Arrest/therapy , Heart Diseases/complications , Humans , Male , Middle Aged , Prognosis , Pyrimidinones/administration & dosage , Pyrimidinones/adverse effects , Survival Analysis , Treatment Outcome , Ventricular Fibrillation/etiology , Ventricular Fibrillation/therapy
2.
Intern Med ; 48(19): 1745-8, 2009.
Article in English | MEDLINE | ID: mdl-19797830

ABSTRACT

In 2008, 1,007 cases of suicide in which hydrogen sulfide was used as a suicidal agent were reported in Japan, and this has become a serious social problem. Here, we report the successful revival of a patient suffering from a severe disturbance of consciousness and respiratory failure caused by hydrogen sulfide poisoning; further, his condition was complicated by myocardial infarction. This is an important case where we examined the tendency toward improvement in myocardial damage in a patient in the acute phase of severe hydrogen sulfide poisoning who was treated for approximately 6 months.


Subject(s)
Heart Failure/chemically induced , Heart Failure/diagnostic imaging , Hydrogen Sulfide/poisoning , 3-Iodobenzylguanidine , Adult , Echocardiography , Electrocardiography , Fatty Acids , Heart Failure/physiopathology , Humans , Iodobenzenes , Male , Organophosphorus Compounds , Organotechnetium Compounds , Radionuclide Imaging , Radiopharmaceuticals , Suicide, Attempted , Time Factors
3.
Tokai J Exp Clin Med ; 32(3): 90-4, 2007 Sep 20.
Article in English | MEDLINE | ID: mdl-21318944

ABSTRACT

Traumatic cardiac tamponade must be treated by pericardial drainage as soon as possible. We recently encountered a rare case of traumatic cardiac tamponade in which the pericardial fluid disappeared spontaneously immediately before the planned drainage. This case is reported in this paper. The patient was a 22-year-old male who was transported to our hospital after he sustained injuries in a traffic accident. The patient was diagnosed to have a facial bone fracture, bilateral lung contusions, myocardial contusion (suspected), injury to the spinal cord at the L3-L4 level, injury to the left kidney and pelvic fracture. After TAE was performed to deal with the bleeding from the injured pelvis, the patient was immediately hospitalized. About 6 hours after the injury, pericardial fluid accumulation began to be noted, and about 18 hours after the injury, the patient went into shock, responding poorly to fluid resuscitation and treatment with pressor agents. At this time, a diagnosis of cardiac tamponade was made and emergency operation was arranged for. However, just before this could be executed, the patient's blood pressure showed a sharp rise, accompanied by disappearance of the pericardial fluid. He continued to show steady improvement and could eventually be discharged from the hospital.


Subject(s)
Cardiac Tamponade/diagnosis , Heart Injuries/complications , Multiple Trauma/complications , Pericardial Effusion/diagnosis , Accidents, Traffic , Adult , Blood Pressure/physiology , Cardiac Tamponade/etiology , Cardiac Tamponade/physiopathology , Heart Injuries/diagnosis , Humans , Male , Multiple Trauma/diagnosis , Pericardial Effusion/etiology , Pericardial Effusion/physiopathology , Remission, Spontaneous , Young Adult
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