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1.
J Cardiovasc Electrophysiol ; 22(2): 131-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20731741

RESUMO

INTRODUCTION: Early repolarization (ERep) abnormalities on electrocardiogram (ECG) are common immediately following cardiac arrest. We characterized and correlated electrocardiographic repolarization abnormalities immediately after cardiac arrest with acute coronary angiography. METHODS AND RESULTS: We studied 225 consecutive patients presenting with out-of-hospital cardiac arrest. All these patients had successful cardiopulmonary resuscitation and acute coronary angiography. The first ECG recorded after successful resuscitation was analyzed by two independent cardiologists. Patients were categorized according to their repolarization pattern. Pattern 1: No ST segment elevation or ERep. Pattern 2: ST segment elevation without ERep. Pattern 3: ST segment elevation and ERep. Pattern 4: ERep only. Patterns 1, 2, 3, and 4 were found in 112 (50%), 74 (33%), 19 (8%), and 20 (9%) patients, respectively. Cardiac arrest was due to acute myocardial ischemia in 45%, 82%, 39%, and 15% of patients in groups 1, 2, 3 and 4, respectively (P < 0.0001). Sensitivity and specificity of pattern 2 was 50% and 88%, respectively, for acute coronary lesion, whereas isolated ERep pattern occurred in 9% of cases and was associated with a nonischemic event (80%). Among 65 patients (29%) who survived, 7% of patients with pattern 1, 13% with pattern 2, 60% with pattern 3, and 88% with pattern 4 exhibited ERep on ECG during the follow-up. CONCLUSION: In the context of cardiac resuscitation, an ECG with ST elevation favors acute myocardial infarction, whereas the presence of ERep is a marker of a nonischemic event and future ERep syndrome.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/estatística & dados numéricos , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/prevenção & controle , Ressuscitação/estatística & dados numéricos , Comorbidade , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco
2.
Eur J Emerg Med ; 18(2): 73-6, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20664351

RESUMO

OBJECTIVES: Coronary angiography is often performed in survivors of out-of-hospital cardiac arrest, but little is known about the factors predictive of a positive coronary angiography. Our aim was to determine these factors. METHODS: In this 7-year retrospective study (January 2000-December 2006) conducted by a French out-of-hospital emergency medical unit, data were collected according to Utstein style guidelines on all out-of-hospital cardiac arrest patients with suspected coronary disease who recovered spontaneous cardiac activity and underwent early coronary angiography. Coronary angiography was considered positive if a lesion resulting in more than a 50% reduction in luminal diameter was observed or if there was a thrombus at an occlusion site. RESULTS: Among the 4621 patients from whom data were collected, 445 were successfully resuscitated and admitted to hospital. Of these, 133 were taken directly to the coronary angiography unit, 95 (71%) had at least one significant lesion, 71 (53%) underwent a percutaneous coronary intervention, and 30 survived [23%, 95% confidence interval (CI): 16-30]. According to multivariate analysis, the factors predictive of a positive coronary angiography were a history of diabetes [odds ratio (OR): 7.1, 95% CI: 1.4-36], ST segment depression on the out-of-hospital ECG (OR: 5.4, 95% CI: 1.1-27.8), a history of coronary disease (OR: 5.3, 95% CI: 1.4-20.1), cardiac arrest in a public place (OR: 3.7, 95% CI: 1.3-10.7), and ventricular fibrillation or ventricular tachycardia as initial rhythm (OR: 3.1, 95% CI: 1.1-8.6). CONCLUSION: Among the factors identified, diabetes and a history of coronary artery were strong predictors for a positive coronary angiography, whereas ST segment elevation was not as predictive as expected.


Assuntos
Angiografia Coronária/métodos , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/mortalidade , Mortalidade Hospitalar/tendências , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Angioplastia Coronária com Balão/métodos , Angioplastia Coronária com Balão/mortalidade , Reanimação Cardiopulmonar/métodos , Intervalos de Confiança , Doença das Coronárias/terapia , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , França , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Admissão do Paciente , Valor Preditivo dos Testes , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
3.
Am J Emerg Med ; 27(9): 1056-9, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19931750

RESUMO

OBJECTIVE: The objective was to assess agreement between end-tidal carbon dioxide values measured by a handheld capnometer (Petco(2)) and values measured by a blood gas analyzer (Paco(2)) in nonintubated patients with respiratory distress in an out-of-hospital setting. METHODS: This prospective study compared Petco(2) values obtained by an end-tidal capnometer (Microcap Plus; Oridion Capnography Inc, Needham, Mass) to Paco(2) values by the Bland and Altman statistical method. RESULTS: A total of 50 patients were included. Continuous Petco(2) monitoring was easily performed in all 50 patients during ambulance transport, but blood gas analysis failed in 1 patient. Agreement between the 2 methods was poor with a bias (mean difference) between Petco(2) and Paco(2) measurements of 12 mm Hg and a precision (SD of the difference) of 8 mm Hg. The gradient between Petco(2) and Paco(2) was greater than 5 and 10 mm Hg in 41 and 25 patients, respectively. CONCLUSIONS: Petco(2) measurements poorly reflected Paco(2) values in our population of nonintubated patients with respiratory distress of various origins.


Assuntos
Capnografia , Síndrome do Desconforto Respiratório/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Gasometria , Serviços Médicos de Emergência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Síndrome do Desconforto Respiratório/sangue , Síndrome do Desconforto Respiratório/etiologia , Volume de Ventilação Pulmonar
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