Lazarus Phenomenon or the Return from the Afterlife-What We Know about Auto Resuscitation.

Autoresuscitation is a phenomenon of the heart during which it can resume its spontaneous activity and generate circulation. It was described for the first time by K. Linko in 1982 as a recovery after discontinued cardiopulmonary resuscitation (CPR). J.G. Bray named the recovery from death the Lazarus phenomenon in 1993. It is based on a biblical story of Jesus' resurrection of Lazarus four days after confirmation of his death. Up to the end of 2022, 76 cases (coming from 27 countries) of spontaneous recovery after death were reported; among them, 10 occurred in children. The youngest patient was 9 months old, and the oldest was 97 years old. The longest resuscitation lasted 90 min, but the shortest was 6 min. Cardiac arrest occurred in and out of the hospital. The majority of the patients suffered from many diseases. In most cases of the Lazarus phenomenon, the observed rhythms at cardiac arrest were non-shockable (Asystole, PEA). Survival time after death ranged from minutes to hours, days, and even months. Six patients with the Lazarus phenomenon reached full recovery without neurological impairment. Some of the causes leading to autoresuscitation presented here are hyperventilation and alkalosis, auto-PEEP, delayed drug action, hypothermia, intoxication, metabolic disorders (hyperkalemia), and unobserved minimal vital signs. To avoid Lazarus Syndrome, it is recommended that the patient be monitored for 10 min after discontinuing CPR. Knowledge about this phenomenon should be disseminated in the medical community in order to improve the reporting of such cases. The probability of autoresuscitation among older people is possible.

Scanning Electron Microscope Examination as an Alternative to Classical Microbiology in the Diagnostics of Catheter-Related Sepsis?

Central venous catheters are essential elements enabling the treatment of intensive care unit patients. However, these catheters are sometimes colonised by both bacteria and fungi, and thus, they may become a potential source of systemic infections-catheter-related bloodstream infections (CRBSI). The identification of the pathogen responsible for CRBSI is a time-consuming process. At the same time, the relationship between the quick identification of the pathogen and the implementation of targeted antibiotic therapy is of key importance for controlling the clinical symptoms of sepsis and septic shock in the patient. Quick diagnosis is of key importance to reduce morbidity and mortality in this group of patients. In our study, we attempted to create a catalogue of images of the most commonly cultured pathogens responsible for CRBSI. An FEI Quanta 250 FEG Scanning Electron Microscope (SEM) was used for measurements. SEM images obtained during the analysis were included in this study. Images of SEM are three-dimensional and comparable to the images seen with the human eye and are a tool used for research and measurement whenever it is necessary to analyse the state of the surface and assess its morphology. The method described in our study will not replace the current procedures recognised as the gold standard, i.e., pathogen culturing, determination of the count of microorganisms (CFU -colony forming units), and assessment of drug sensitivity. However, in some cases, the solution proposed in our study may aid the diagnosis of patients with suspected catheter-related bloodstream infections leading to sepsis and septic shock.

Population Pharmacokinetic-Pharmacodynamic Modeling and Probability of Target Attainment Analysis of Rocuronium and Sugammadex in Children Undergoing Surgery.

BACKGROUND AND OBJECTIVES: Probability of target attainment (PTA) curves are commonly used to support dose recommendations of antibiotics for different patient groups. In this study we propose PTA analysis to optimize sugammadex dosing in children. METHODS: This study involved data from an observational cohort study of 30 American Society of Anesthesiologists (ASA) Physical Status I and II children undergoing surgery requiring muscle relaxation. All patients received 0.6 mg/kg rocuronium, with sugammadex administered at the end of surgery in three different doses (0.5, 1.0, and 2.0 mg/kg) to reverse the neuromuscular blockade. RESULTS: The data were analyzed using a population Bayesian-based approach. The developed model was used to simulate pharmacokinetic-pharmacodynamic profiles for different patient groups and dosing regimens before the PTA analysis was performed to translate these simulations into a clinically useful measure. The target was defined as neuromuscular blockade reversal measured by Train-of-Four (TOF ratio > 90%) at 1.5, 3, and 5 min post sugammadex dose. The sugammadex doses leading to 90% PTA were determined for different patients' body weights, rocuronium doses, and time gaps between rocuronium and sugammadex administration assuming the model, priors, and gathered data. For comparison, PTA curves for a range of clinical scenarios are provided to illustrate the usefulness of PTA analysis in selecting the appropriate dose for a given patient. CONCLUSIONS: The proposed PTA analysis is useful to support the sugammadex dose selection in different clinical scenarios. TRIAL REGISTRATION: The study was registered by ClinicalTrials.gov under number NCT04851574 on 21 April 2021.

Do Different Sources of Knowledge and Multiculturalism of Dental and Medical Students Affect the Level of First Aid Education? Do Medical Stereotypes Exist?

BACKGROUND: The aim of the study was to assess the impact of having various sources of information in the field of first aid on the level of knowledge of dental and medical students, as well as to recognize if medical stereotypes exist in the domain of first aid. METHODS: We tested 818 Native-(N) and English (E)-speaking students of medicine (M) and dentistry (D). The questionnaire was constructed in a way that it could detect the issues which created the biggest challenges to the students. It consisted of both theoretical and clinical questions. The intention was to find out whether there were any medical stereotypes. The students were asked to provide the sources of their knowledge to each question, and information about the presence of first aid classes at school. RESULTS: We found medical stereotypes, but only in the questions pertaining to theory: questions concerning defibrillation, opening the airway in infants and the causes of airway obstruction of an unconscious adult. Correlations were found between the sources of knowledge with answers to the questions in each group of students and between the groups. The sources of knowledge in N students came mostly from school, or the students were not able (NA) to indicate the source of knowledge, but E groups gave out of school courses, mass media and their own knowledge (or from the others), as well as NA answers. Interestingly in ED group, among other answers, students also indicated schools as a source of their knowledge. CONCLUSIONS: We confirmed that medical stereotypes among dental and medical students exist, and they were not related to multiculturalism or the use of different sources of knowledge.

Carbon dioxide as a potential danger to medical rescue teams at work - A case study.

Medical rescue teams might be exposed to the risk of accidental poisoning while performing rescue procedures. Exposure to the risk of lethal carbon dioxide (CO2) concentrations is a rare situation. This case study describes rescuing a patient who suffered from sudden cardiac arrest due to accidental CO2 poisoning. The victim was finally evacuated and resuscitated, but the circumstances of the rescue operation point to the need to equip ambulances with carbon dioxide detectors and hermetic oxygen masks. Med Pr 2017;68(1):135-138.

Non-word reading test vs anaesthesia. How do anaesthetised patients decode the contents without referring to the meaning?

BACKGROUND: The aim of this study was to examine the phonological functioning (reading speed and accuracy) of hospital patients under general anaesthesia administered during colonoscopy. METHODS: In this study the 'Latysz' non-word reading test was used to measure the impact of selected anaesthetics on the phonological aspect of language processing (defined as decoding without referring to the meaning) in a group of 22 anaesthetised patients compared to 23 non-anaesthetised patients from university clinics. RESULTS: Compared to the preoperative performance, a decrease in reading accuracy and reading speed was observed only in the Anaesthesia Group - AG (in the subjects aged ≥ 35 years) 1.5 h after the administration of anaesthetics. Postoperatively, the AG were significantly slower and less accurate than the Control Group - CG - after 1.5 h. After 3 h, the AG had regained their baseline values both in reading accuracy and reading speed. During the last assessment session, the AG pronounced 82% of the words correctly, while the CG pronounced 74% correctly. Moreover, subjects aged ≥ 35 years performed worse than younger subjects in their reading accuracy and speed. CONCLUSIONS: The patients who underwent colonoscopy under general anaesthesia manifested impaired phonological functioning shortly after the procedure, both in the speed and accuracy of reading non-words. However, the accuracy problems subsided relatively quickly.

Pharmacokinetics and pharmacodynamics of propofol in children undergoing different types of surgeries.

BACKGROUND: Propofol is a commonly used agent in total intravenous anesthesia (TIVA). However, the link between its pharmacokinetics and pharmacodynamics has not been fully characterized in children yet. Our aim was to determine the quantitative relationship between the venous plasma concentration and bispectral index (BIS) effect in a heterogeneous group of pediatric patients undergoing various surgical procedures (ASA status I-III). METHODS: Nine male and nine female patients were anesthetized with propofol-fentanyl TIVA. Sparse venous samples for propofol concentrations assay and dense BIS measurements were collected during and after the end of infusion. Nonlinear mixed-effect modeling in NONMEM was used for data analysis. RESULTS: A three-compartment model was linked with a classical Emax model through a biophase compartment to describe the available data. All clearance and volume terms were allometrically scaled to account for the body mass difference among the patients under study. A typical patient had their PK parameters observed within the range of literature values for children. The pharmacodynamic parameters were highly variable. The EC50 of 2.80 mg/L and the biophase distribution rate constant of 3.33 min(-1) were found for a typical patient. CONCLUSIONS: The BIS values in children are highly correlated with the propofol effect compartment concentrations according to the classical Emax concentration-response relationship. Children had slightly lower sensitivity to propofol and slightly higher clearance, as compared with the adult data available in literature. The intra-patient variations in the BIS require the anesthesiologist's attention in using BIS values alone to evaluate the depth of anesthesia in children.

Procedural sedation and analgesia in children undergoing digestive endoscopic procedures - paediatrician or anaesthesiologist?

Endoscopic procedures of the gastrointestinal tract were successfully introduced into paediatric practice in the 1970s. Recent expansive development has become useful for improvement of both diagnosis and treatment in many children with gastrointestinal diseases. Most of these procedures are performed under procedural sedation (PSA) knowing anatomical, physiological and psychological differences and requiring good experience from the paediatrician and anaesthesiologist. These principles help to provide the procedure safely and minimise adverse events, which are greater the smaller the child is. Procedural sedation and analgesia in healthy children can be performed by a paediatrician, but children with congenital defects and serious coexisting diseases (ASA ≥ III) and also during the usage of anaesthetics (e.g. propofol), should be managed by an anaesthesiologist.

Procedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?

Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation's 'Safe Surgery Saves Lives' initiative including the 'Surgical Safety Checklist'. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.

Evaluation of the Trail Making Test and interval timing as measures of cognition in healthy adults: comparisons by age, education, and gender.

BACKGROUND: Human cognitive functioning can be assessed using different methods of testing. Age, level of education, and gender may influence the results of cognitive tests. MATERIAL AND METHODS: The well-known Trail Making Test (TMT), which is often used to measure the frontal lobe function, and the experimental test of Interval Timing (IT) were compared. The methods used in IT included reproduction of auditory and visual stimuli, with the subsequent production of the time intervals of 1-, 2-, 5-, and 7-seconds durations with no pattern. Subjects included 64 healthy adult volunteers aged 18-63 (33 women, 31 men). Comparisons were made based on age, education, and gender. RESULTS: TMT was performed quickly and was influenced by age, education, and gender. All reproduced visual and produced intervals were shortened and the reproduction of auditory stimuli was more complex. Age, education, and gender have more pronounced impact on the cognitive test than on the interval timing test. The reproduction of the short auditory stimuli was more accurate in comparison to other modalities used in the IT test. CONCLUSIONS: The interval timing, when compared to the TMT, offers an interesting possibility of testing. Further studies are necessary to confirm the initial observation.

Assessing circadian rhythms during prolonged midazolam infusion in the pediatric intensive care unit (PICU) children.

BACKGROUND: This study evaluates possible circadian rhythms during prolonged midazolam infusion in 27 pediatric intensive care unit (PICU) children under mechanical ventilation. METHODS: Blood samples for midazolam and 1-OH-midazolam assay were collected throughout the infusion at different times of the day. The blood pressure, heart rate and body temperature were recorded every hour for the rhythms analysis. Population nonlinear mixed-effect modeling with NONMEM was used for data analysis. RESULTS: A two-compartment model for midazolam pharmacokinetics and a one-compartment model for midazolam metabolite adequately described the data. The 24 h profiles of all monitored physiological parameters were greatly disturbed/abolished in comparison with the well-known 24 h rhythmic patterns in healthy subjects. There was no significant circadian rhythm detected with respect to midazolam pharmacokinetics, its active metabolite pharmacokinetics and all monitored parameters. CONCLUSIONS: We concluded that the light-dark cycle did not influence midazolam pharmacokinetics in intensive care units children. Also, endogenous rhythms in critically ill and sedated children are severely disturbed and desynchronized. Our results confirmed that it is necessary to adjust the dose of midazolam to the patient's body weight. The low value of midazolam clearances observed in our study was probably caused by mechanical ventilation, which was shown to decrease the cardiac output.

Psychomotor functions and interval timing in patients receiving intravenous anesthesia for endoscopic procedures: the pilot study.

Introduction. The aim of this study was to evaluate two measures in a cognitive examination: psychomotor function and the perception of time (PT) in patients after intravenous anesthesia for endoscopic procedures. Material and Methods. We tested 23 anesthetized patients (Anesthesia Group, AG) and 17 not anesthetized patients (Control Group, CG). The Dufour Cross-Shaped Apparatus (DA) was used to assess quick reactions. Perception of time (PT) was measured for 1-, 2-, 5-, and 7-second intervals. The tests were performed before the anesthesia was administered and 1.5, 3, and 6 hours after the procedure was completed. Results. The intervals that were generated and the reproduced visual stimuli were shorter than the patterns. The reproduced 1- and 2-second auditory stimuli were longer than the patterns. The remaining reproduced auditory impulses were shorter than the patterns. Conclusions. In anesthetized patients, quick psychomotor reactions and the ability to time intervals are preserved 1.5 h and later after intravenous anesthesia for endoscopy.

The quality of defibrillation performance among students of the University of Medical Sciences.

The major objective was to assess the time period from a witnessed ventricular fibrillation (VF) to the first defibrillation (DEF) in a simulated manikin scenario, while the minor objective was to analyze the most common errors that occurred during DEF and the maintenance of 2-min intervals during resuscitation. We examined 210 students (medical faculty students, MF; and paramedic faculty students, PF) who had to treat a patient with VF. In the study we used the Laerdal(®) Training Manikin and the Zoll M Series(®) defibrillator. The mean time period from the witnessed VF to the first DEF was 50.1 s (SD 32.5 s) in the MF group and 62.9 s (SD 36.9 s) in the PF group (no statistically significant difference). The delay resulted from the lack of constant ECG monitoring and charging in the option "Monitor" instead of the option "Defibrillation." The PF group shortened the 2-min cycles between defibrillations. The problems observed during the study were technical and educational. We concluded that the option "Monitor" should be removed from the equipment because it seems to be redundant. The teaching problems were a lack of constant ECG monitoring, incorrect handling of the defibrillator, and not keeping to 2-min loops of CPR.

A survey of anaesthesiology residents' knowledge of resuscitation guidelines.

BACKGROUND: Several surveys have been published, documenting the lack of knowledge of cardiopulmonary resuscitation (CPR) among anaesthesiology residents. As a result, we decided to assess the competency of local trainees in basic and advanced CPR. METHODS: The survey was conducted among 26 residents in anaesthesiology who were asked twice (at the beginning, and at the end of refresher courses) to complete an open test on adult and paediatric CPR guidelines. RESULTS: The results in the first, introductory surveys were poor. Most of the wrong answers concerned the age borderline between an adult and a child; the correct CPR sequences and their modification in children; and paediatric medication. The respondents were not able to define all reversible causes of cardiac arrest. The second survey were somewhat better, but the respondents could still not name the correct lidocaine dosage in all age groups. CONCLUSIONS: Residents in anaesthesiology show the tendency their knowledge of resuscitation guidelines to decay. Refresher life support courses should be mandatory for this group of physicians.

[A survey of basic resuscitation knowledge among medical personnel of a paediatric hospital]. / Personel medyczny szpitala pediatrycznego nie ma wystarczajacej wiedzy dotyczacej prowadzenia bezprzyrzadowej resuscytacji krazeniowo-oddechowej.

BACKGROUND: The European Resuscitation Council (ERC) algorithms for cardiopulmonary resuscitation have undergone many changes, the latest version being published in 2005.To establish the level of general knowledge of resuscitation algorithms, we audited physicians and nurses in a tertiary paediatric hospital. METHODS: The audit was performed among 64 physicians and 54 nurses. They were allocated to the following subgroups: surgeons, paediatricians, surgical nurses, and non-surgical nurses. A written open examination was conducted, containing response questions on basic resuscitation of adults, children and infants. The participants also completed a questionnaire concerning their knowledge of current guidelines and their activity in continuing education. RESULTS: The vast majority of those audited were not familiar with the 2005 ERC guidelines. Most of the physicians and nurses were not able to differentiate between an adult and a child.They did not know the recommended number of artificial breaths to be delivered to a patient with preserved cardiac function, or the number of resuscitation cycles (delivered by one or two rescuers). They could not describe the open airway manoeuvres and volumes of artificial breaths. Depending on subgroups, only 14.3-84.6% of participants knew how to deliver chest compressions to adults, 21.4-80.8% knew how to deliver them to children, and 19.2-75.4% knew how to deliver them to infants. 17.8-23.1% of nurses and 28.6-47.4% of physicians had completed basic life support courses. 0-14.3% of nurses and few physicians declared a familiarity with the 2005 guidelines, but only 35% of them were aware of the latest modifications. CONCLUSION: The medical staff of a paediatric hospital was not adequately trained in cardiopulmonary resuscitation and their knowledge about current recommendations was minimal. The authors suggest that life support courses should be mandatory for all physicians and nurses.

The first attempt at initiating problem-based learning as a method of teaching-learning at the University of Medical Sciences in Poznan, Poland.

The main objective of problem-based learning (PBL) is to provoke students to solve a new problem by themselves. The aim of this study was to investigate whether PBL was a better method of teaching basic and advanced life support to medical students compared with the classical method. The research was undertaken in 2002 in accordance with the European Guidelines 2000 and involved 36 medical students in year 4. The students were divided into two groups: experimental PBL group (17 students) and the control-classical method group (19 students). After the advanced life support course, the students wrote two tests to assess their knowledge on how to open the airway and how to perform basic and advanced resuscitation. The questions contained true or false answers. The students' skills of basic and advanced methods of opening the airway and advanced resuscitation were checked by practical tests. The Mann-Whitney test was used for statistical analysis. The experimental PBL group received significantly better results: 30-45 points (mean, 38.29 points) and 30-47 points (mean, 40.94 points) for the written and practical tests, respectively, compared with the control-classical group (22-34 points [mean, 29.36 points] and 22-35 points [mean, 28.63 points], respectively). Therefore, PBL offers a better method for teaching basic and advanced life support to medical students compared with the classical method.

[Medical personnel in a paediatric hospital do not possess adequate cardiopulmonary resuscitation skills]. / Personel medyczny szpitala pediatrycznego nie ma wystarczajacych umiejetnosci prowadzenia resuscytacji krazeniowo-oddechowej.

BACKGROUND: The main changes to the European Resuscitation Guidelines in 2005 were relate to the tidal volume of artificial breaths, the position and depth of chest compressions, and th number of resuscitation cycles. To find out if these guidelines were widely known, we assessed the knowledge and skills of physicians and nurses working in a paediatric hospital. METHODS: During practical sessions, the skills of 118 employees (64 physicians and 54 nurses) were assessed when performing resuscitation on adult, child and infant AMBU manikins. Additionally, all participants completed self-assessment questionnaires. RESULTS: The main fault was the inadequate checking of the airway in adults. Only 53.6% of physicians and 71.9% of nurses could properly open the airway, and 85.7% of physicians and 50.0% of nurses correctly placed their heads above the victim's face when observing chest movements. Nearly 45% of nurses, and 100% of physicians delivered the correct tidal volume to adults, however it was frequently associated with marked gastric distension, in both adults and infants. The participants usually positioned their hands or fingers correctly on the manikin's chest, but delivered slow and shallow compressions. Almost 50% of participants graded their skills as inadequate. CONCLUSION: Despite continuous education, the resuscitation skills of physicians and nurses from a paediatric hospital were far from satisfactory. The results indicate an urgent need for regular training.