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1.
Circ J ; 85(10): 1842-1848, 2021 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-34261843

RESUMO

BACKGROUND: The effect of in-hospital rapid cooling by intravenous ice-cold fluids for comatose survivors of out-of-hospital cardiac arrest (OHCA) is unclear.Methods and Results:From the J-PULSE-HYPO study registry, data for 248 comatose survivors with return of spontaneous circulation (ROSC) who were treated with therapeutic hypothermia (34℃ for 12-72 h) after witnessed shockable OHCA were extracted. Patients were divided into 2 groups by the median collapse-to-ROSC interval (18 min), and then into 2 groups by cooling method (rapid cooling by intravenous ice-cold fluids vs. standard cooling). The primary endpoint was favorable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after OHCA. In the whole cohort, the shorter collapse-to-ROSC interval group had significantly higher favorable neurological outcome than the longer collapse-to-ROSC interval group (78.2% vs. 46.8%, P<0.001). In the shorter collapse-to-ROSC interval group, no significant difference was observed in favorable neurological outcome between the 2 cooling groups (rapid cooling group: 79.4% vs. standard cooling group: 77.0%, P=0.75). In the longer collapse-to-ROSC interval group, however, favorable neurological outcome was significant higher in the rapid cooling group than in the standard cooling group (60.7% vs. 33.3%, P<0.01) and the adjusted odds ratio after rapid cooling was 3.069 (95% confidence interval 1.423-6.616, P=0.004). CONCLUSIONS: In-hospital rapid cooling by intravenous ice-cold fluids improved neurologically intact survival in comatose survivors whose collapse-to-ROSC interval was delayed over 18 min after shockable OHCA.


Assuntos
Reanimação Cardiopulmonar , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Reanimação Cardiopulmonar/métodos , Coma/etiologia , Coma/terapia , Hospitais , Humanos , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/métodos , Gelo , Infusões Intravenosas , Parada Cardíaca Extra-Hospitalar/terapia , Sobreviventes
2.
Resuscitation ; 146: 170-177, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31394154

RESUMO

AIM: The European Resuscitation Council guidelines recommend a slow rate of rewarming of 0.25 °C/h-0.5 °C/h for out-of-hospital cardiac arrest (OHCA) patients receiving therapeutic hypothermia (TH). Conversely, a very slow rewarming of 1 °C/day is generally applied in Japan. The rewarming duration ranged from less than 24 h up to more than 50 h. No randomized control trials have examined the optimal rewarming speed for TH in OHCA patients. Therefore, we examined the association between the rewarming duration and neurological outcomes in OHCA patients who received TH. METHODS: This study was a secondary analysis of the Japanese Population-based Utstein-style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia (J-PULSE-HYPO) study registry, a multicenter prospective cohort study. Patients suffering from OHCA who received TH (target temperature, 34 °C) after the return of spontaneous circulation from 2005 to 2011 in 14 hospitals throughout Japan were enrolled. The rewarming duration was defined as the time from the beginning of rewarming at a target temperature of 34 °C until reaching 36 °C. The primary outcome was an unfavorable neurological outcome at hospital discharge, i.e., a cerebral performance category of 3-5. RESULTS: The J-PULSE-HYPO study enrolled 452 OHCA patients. Of these, 328 were analyzed; 79.9% survived to hospital discharge, of which 56.4% had a favorable neurological outcome. Multivariable logistic regression analysis revealed that the rewarming duration was independently associated with unfavorable neurological outcomes [odds ratio (per 5 h), 0.89; 95% confidence interval, 0.79-0.99; p =  0.032]. CONCLUSION: A longer rewarming duration was significantly associated with and was an independent predictor of favorable neurological outcomes in OHCA patients who received TH.


Assuntos
Reanimação Cardiopulmonar , Duração da Terapia , Hipotermia Induzida/métodos , Doenças do Sistema Nervoso , Parada Cardíaca Extra-Hospitalar , Reaquecimento , Reanimação Cardiopulmonar/efeitos adversos , Reanimação Cardiopulmonar/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Neuroproteção , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros/estatística & dados numéricos , Retorno da Circulação Espontânea/fisiologia , Reaquecimento/efeitos adversos , Reaquecimento/métodos , Resultado do Tratamento
3.
Crit Care Med ; 46(9): e881-e888, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29957713

RESUMO

OBJECTIVES: Bradycardia during therapeutic hypothermia has been reported to be a predictor of favorable neurologic outcomes in out-of-hospital cardiac arrests. However, bradycardia occurrence rate may be influenced by the target body temperature. During therapeutic hypothermia, as part of the normal physiologic response, heart rate decreases in the cooling phase and increases during the rewarming phase. We hypothesized that increased heart rate during the rewarming phase is another predictor of favorable neurologic outcomes. To address this hypothesis, the study aimed to examine the association between heart rate response during the rewarming phase and neurologic outcomes in patients having return of spontaneous circulation after out-of-hospital cardiac arrest. DESIGN: A secondary analysis of the Japanese Population-based Utstein style study with defibrillation and basic/advanced Life Support Education and implementation-Hypothermia registry, which was a multicenter prospective cohort study. SETTING: Fourteen hospitals throughout Japan. PATIENTS: Patients suffering from out-of-hospital cardiac arrest who received therapeutic hypothermia after the return of spontaneous circulation from 2005 to 2011. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: This study enrolled 452 out-of-hospital cardiac arrest patients, of which 354 were analyzed, and 80.2% survived to hospital discharge, of which 57.3% had a good neurologic outcome. Heart rate response was calculated using heart rate data recorded during therapeutic hypothermia in the abovementioned registry. Heart rate response in the rewarming phase (heart rate response-rewarming) was calculated as follows: (heart rate [post rewarming]-heart rate [pre rewarming])/heart rate (pre rewarming) × 100. The primary outcome was an unfavorable neurologic outcome at hospital discharge, that is, a Cerebral Performance Category of 3-5. Multivariable logistic regression analysis was performed to determine the association between heart rate response-rewarming and unfavorable neurologic outcomes. Multivariable logistic regression analysis showed that heart rate response-rewarming was independently associated with unfavorable outcomes (odds ratio [per 10% change], 0.86; 95% CI, 0.78-0.96; p = 0.004). CONCLUSIONS: Increased heart rate in the approximately 48-hour rewarming phase during therapeutic hypothermia was significantly associated with and was an independent predictor of favorable neurologic outcomes during out-of-hospital cardiac arrest.


Assuntos
Frequência Cardíaca , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Hipotermia Induzida/métodos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Parada Cardíaca Extra-Hospitalar/complicações , Estudos Prospectivos , Reaquecimento , Fatores de Tempo , Resultado do Tratamento
4.
Circ J ; 79(10): 2201-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26212234

RESUMO

BACKGROUND: Because the initial (on admission) Glasgow Coma Scale (GCS) examination has not been fully evaluated in comatose survivors of cardiac arrest (CA) who receive therapeutic hypothermia (TH), the aim of the present study was to determine any association between the admission GCS motor score and neurologic outcomes in patients with out-of-hospital CA who receive TH. METHODS AND RESULTS: In the J-PULSE-HYPO study registry, patients with bystander-witnessed CA were eligible for inclusion. Patients were divided into 3 groups based on GCS motor score (1, 2-3, and 4-5) to assess various effects on neurologic outcome. Univariate and multivariate analyses were performed to identify independent predictors of good neurologic outcome at 90 days. Of 452 patients, 302 were enrolled. There was a significant difference among the 3 patient groups with regard to neurologic outcome at 90 days in the univariate analysis. Multiple logistic regression analyses showed that the GCS motor score on admission, age >65 years, bystander cardiopulmonary resuscitation, the time from collapse to return of spontaneous circulation, and pupil size <4 mm were independent predictors of a good neurologic outcome at 90 days in cases of CA (GCS motor score, 4-5: odds ratio, 8.18; 95% confidence interval: 1.90-60.28; P<0.01). CONCLUSIONS: GCS motor score is an independent predictor of good neurologic outcome at 90 days in patients sustaining out-of-hospital CA who receive TH.


Assuntos
Coma , Hipotermia Induzida , Parada Cardíaca Extra-Hospitalar , Sistema de Registros , Idoso , Coma/mortalidade , Coma/fisiopatologia , Coma/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Parada Cardíaca Extra-Hospitalar/terapia
5.
J Intensive Care ; 3(1): 28, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26097741

RESUMO

BACKGROUND: Therapeutic hypothermia (TH) is a standard strategy to reduce brain damage in post-cardiac arrest syndrome (PCAS) patients. However, it is unknown whether the target temperature should be adjusted for PCAS patients in different states. METHODS: Participants in the J-PULSE-Hypo study database were divided into lower (32.0-33.5 °C; Group L) or moderate (34.0-35.0 °C; Group M) temperature groups. Primary outcome was a favourable neurological outcome (proportion of patients with a Glasgow-Pittsburgh Cerebral Performance Category [CPC] of 1-2 on day 30). We compared between the two groups and in subgroups of patients divided by age and resuscitation interval (interval from collapse to return of spontaneous circulation) by propensity score (PS) analysis. RESULTS: Overall, 467 participants were analysed. The proportions of patients with favourable neurological outcomes were as follows (Group L vs. Group M) (OR; Odds ratio): all patients, 64 % (n = 42) vs. 55 % ((n = 424) (PS; OR 1.381 (0.596-3.197)), P = 0.452) and resuscitation interval ≤ 30 min, 88 % (n = 24) vs. 64 % ((n = 281) (PS; OR 7.438 (1.769-31.272)), P = 0.007). CONCLUSIONS: PCAS patients with a resuscitation interval of <30 min may be candidates for TH with a target temperature of <34 °C. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000001935; available at: https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000002348&language=J.

6.
PLoS One ; 10(3): e0121078, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25781957

RESUMO

BACKGROUND: Posttraumatic pseudoaneurysms (PAs) have been recognized as the cause of delayed hemorrhage complicated with nonoperative management (NOM), although the need for intervention in patients with small-sized PAs and the relationship between the occurrence of PAs and bed-rest has been also unclear. OBJECTIVES: The purpose of this study was to investigate the clinical history of small-sized PAs (less than 10 mm in diameter) which occurred in abdominal solid organs, and to analyze the relationship between the occurrence of PAs and early mobilization from bed. METHODS: Sixty-two patients who were successfully managed with NOM were investigated. Mobilization within three days post-injury was defined as "early mobilization" and bed-rest lasting over three days was defined as "late mobilization." A comparison of the clinical factors, including the duration of bed-rest between patients with and without PAs detected by follow-up CT was performed. Furthermore, a multiple logistic regression model analysis on the occurrence of PAs was performed. RESULTS: PAs were detected in 7 of the 62 patients. The One patient with PAs measuring larger than 10 mm received trans-arterial embolization, and the remaining six patients with PAs smaller than 10 mm were managed conservatively. Consequently, no delayed hemorrhage occurred, and the PAs spontaneously disappeared in all of the six patients managed without intervention. The multiple regression model analysis revealed that early mobilization was not a significant factor predicting new-onset PAs. CONCLUSIONS: Small PAs can be expected to disappear spontaneously. Moreover, early mobilization is not a significant risk factor for the occurrence of PAs.


Assuntos
Traumatismos Abdominais/terapia , Falso Aneurisma/terapia , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/etiologia , Falso Aneurisma/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/patologia
7.
Acute Med Surg ; 2(4): 257-259, 2015 10.
Artigo em Inglês | MEDLINE | ID: mdl-29123734

RESUMO

Case: A 64-year-old man was injured after falling from a height of 5 m and was transported to our institution. On presentation, his hemodynamic state was unstable, and both focused assessment with sonography for trauma and enhanced computed tomography imaging revealed massive left pleural effusion, but no pericardial effusion. He went into cardiopulmonary arrest just before surgery, so an urgent left anterolateral thoracotomy followed by open chest cardiac massage and aortic clamping were carried out. By performing an additional right anterior thoracotomy, a left pleuropericardial laceration and a perforation measuring 1 cm in diameter at the left ventricle were found. The patient's dynamic state stabilized following the restoration of hemostasis by suturing the rupture site. Outcome: The patient's postoperative course was favorable, and he was discharged after 20 days of hospitalization. Conclusion: Blunt cardiac and pericardial injury rarely causes massive hemothorax with no hemopericardium, resulting in hemorrhagic shock.

8.
PLoS One ; 9(6): e99915, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24926782

RESUMO

BACKGROUND: The level of intestinal fatty acid-binding protein (I-FABP) is considered to be useful diagnostic markers of small bowel ischemia. The purpose of this retrospective study was to investigate whether the serum I-FABP level is a predictive marker of strangulation in patients with small bowel obstruction (SBO). METHODS: A total of 37 patients diagnosed with SBO were included in this study. The serum I-FABP levels were retrospectively compared between the patients with strangulation and those with simple obstruction, and cut-off values for the diagnosis of strangulation were calculated using a receiver operating characteristic curve. In addition, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Twenty-one patients were diagnosed with strangulated SBO. The serum I-FABP levels were significantly higher in the patients with strangulation compared with those observed in the patients with simple obstruction (18.5 vs. 1.6 ng/ml p<0.001). Using a cut-off value of 6.5 ng/ml, the sensitivity, specificity, PPV and NPV were 71.4%, 93.8%, 93.8% and 71.4%, respectively. An I-FABP level greater than 6.5 ng/ml was found to be the only independent significant factor for a higher likelihood of strangulated SBO (P =  0.02; odds ratio: 19.826; 95% confidence interval: 2.1560 - 488.300). CONCLUSIONS: The I-FABP level is a useful marker for discriminating between strangulated SBO and simple SBO in patients with SBO.


Assuntos
Biomarcadores/sangue , Proteínas de Ligação a Ácido Graxo/sangue , Obstrução Intestinal/sangue , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos
9.
Circ J ; 76(11): 2579-85, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22813874

RESUMO

BACKGROUND: Although therapeutic hypothermia is an effective therapy for comatose adults experiencing out-of-hospital shockable cardiac arrest, there is insufficient evidence that is also applicable for those with out-of-hospital non-shockable cardiac arrest. METHODS AND RESULTS: Of 452 comatose adults treated with therapeutic hypothermia after return of spontaneous circulation (ROSC) subsequent to an out-of-hospital cardiac arrest of cardiac etiology, 372 who had a bystander-witnessed cardiac arrest, target core temperature of 32-34°C and cooling duration of 12-72 h were eligible for this study (75 cases of non-shockable cardiac arrest, 297 cases of shockable cardiac arrest). The median collapse-to-ROSC interval was significantly longer in the non-shockable group than in the shockable group (30 min vs. 22 min, P=0.008), resulting in a significantly lower frequency of 30-day favorable neurological outcome in the non-shockable group compared with the shockable group (32% vs. 66%, P<0.001). However, an analysis of data in quartiles assigned to varying lengths of collapse-to-ROSC interval revealed a similar frequency of 30-day favorable neurological outcome among both groups when the collapse-to-ROSC interval was ≤16 min (90% non-shockable group vs. 92% shockable group; odds ratio 0.80, 95% confidence interval 0.09-7.24, P=0.84). CONCLUSIONS: Post-ROSC cooling is an effective treatment for patients with non-shockable cardiac arrest when the time interval from collapse to ROSC is short.


Assuntos
Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Taxa de Sobrevida
10.
Circ J ; 75(5): 1063-70, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21471669

RESUMO

BACKGROUND: Mild hypothermia is an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. However, evidence of the effectiveness of therapeutic hypothermia (TH) remains unclear. METHODS AND RESULTS: A multicenter registry in Japan (J-PULSE-HYPO study registry) was conducted to investigate the effectiveness of TH for post-resuscitation neurological dysfunction developing after out-of-hospital cardiac arrest from 14 institutions, between January 2005 and December 2009. The committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming. There were 452 patients (375 men) enrolled into the registry. The mean age was 58.6 ± 13.5 years. Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. The median interval from the occurrence of cardiac arrest to ROSC was 26 min. The target core temperature during TH was 33.9 ± 0.4°C and the mean duration of cooling was 31.5 ± 13.9 h. Intra-aortic balloon pumping was used in 40.1% and percutaneous cardiopulmonary support in 22.6% of patients. At 30 days after cardiac arrest, the proportion of survival was 80.1% and the proportion of patients with favorable neurological functions, with a cerebral performance category score of 1 or 2, was 55.3%. CONCLUSIONS: The J-PULSE-HYPO study registry showed a clinical aspect of TH.


Assuntos
Hipotermia Induzida/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Ressuscitação/métodos , Idoso , Angioplastia , Reanimação Cardiopulmonar , Eletrocardiografia , Feminino , Humanos , Hipotermia Induzida/mortalidade , Balão Intra-Aórtico , Japão , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Sistema de Registros , Ressuscitação/mortalidade , Taxa de Sobrevida , Temperatura
11.
Circ J ; 74(11): 2308-13, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20877128

RESUMO

BACKGROUND: Nifekalant hydrochloride (NIF) is an intravenous class-III antiarrhythmic agent that purely blocks the K(+)-channel without inhibiting ß-adrenergic receptors. The present study was designed to investigate the feasibility of NIF as a life-saving therapy for out-of-hospital ventricular fibrillation (VF). METHODS AND RESULTS: The Japanese Population-based Utstein-style study with basic and advanced Life Support Education study was a multi-center registry study with 4 participating institutes located at the northern urban area of Osaka, Japan. Eligible patients were those treated with NIF because of out-of-hospital VF refractory to 3 or more precordial shocks and intravenous epinephrine. Between February 2006 and February 2007, 17 patients were enrolled for the study. The time from a call for emergency medical service to the first shock was 12(6-26)min. The time from the first shock to the NIF administration was 25.5(9-264)min and the usage dose of NIF was 25(15-210)mg. When excluding 3 patients in whom percutaneous extracorporeal membrane oxygenation was applied before NIF administration, the rate of return of spontaneous circulation was 86% and the rate of admission alive to the hospital was 79%. One patient developed torsade de pointes. CONCLUSIONS: Intravenous administration of NIF seems to be feasible as a potential therapy for advanced cardiac life-support in patients with out-of-hospital VF, and therefore further study is warranted.


Assuntos
Antiarrítmicos/administração & dosagem , Cardioversão Elétrica , Parada Cardíaca Extra-Hospitalar/terapia , Pirimidinonas/administração & dosagem , Fibrilação Ventricular/terapia , Idoso , Desfibriladores , Cardioversão Elétrica/instrumentação , Eletrocardiografia , Estudos de Viabilidade , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Parada Cardíaca Extra-Hospitalar/etiologia , Parada Cardíaca Extra-Hospitalar/mortalidade , Admissão do Paciente , Projetos Piloto , Estudos Prospectivos , Sistema de Registros , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Torsades de Pointes/induzido quimicamente , Falha de Tratamento , Fibrilação Ventricular/complicações , Fibrilação Ventricular/tratamento farmacológico , Fibrilação Ventricular/mortalidade
12.
J Cardiol Cases ; 1(3): e147-e150, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30524525

RESUMO

A 31-year-old man suddenly collapsed at work. His colleagues witnessed the event, applied basic life support, and called for an ambulance. After the ambulance arrived, the initial rhythm was confirmed as ventricular fibrillation (VF) and he was defibrillated with an automated external defibrillator. Spontaneous circulation was regained at 8 min after collapse. He was thought to be a good candidate for therapeutic hypothermia because he was comatose and had survived outside hospital VF cardiac arrest due to cardiac etiology. However, he was taking immunosuppressive drugs after undergoing a kidney transplant. We obtained written, informed consent from the patient's family to start therapeutic hypothermia at 33.5-34.5 °C for 48 h, although he was at high risk for such induction. Serious complications and neurological deficits did not develop and the patient was referred to another hospital on day 42 for implantation with a cardioverter defibrillator.

15.
Circ J ; 72(1): 51-5, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18159099

RESUMO

BACKGROUND: Asymptomatic acute ischemic stroke (aAIS) following primary percutaneous coronary intervention (p-PCI) in patients with acute coronary syndrome (ACS) has not been studied in detail. METHODS AND RESULTS: Of 75 patients who underwent p-PCI, 26 (34.7%) developed aAIS as determined by diffusion-weighted magnetic resonance imaging (MRI). Including the approach to the coronary artery (via lower limb or right upper limb), 23 factors were compared between patients with (n=26) and without (n=49) aAIS. Age, hypertension, smoking, plasma glucose levels, Killip grade, right coronary artery (RCA) as culprit vessel, percutaneous coronary intervention (PCI) time, and the frequency of device insertion into the coronary artery differed in a statistically significant manner. However, multivariate analysis showed that the RCA (odds ratio 3.477) and the frequency of device insertion (1.375) were independent factors linked to the incidence of aAIS. Moreover, anterior or posterior location and left or right cerebral circulation of aAIS were equivalent in both approaches. CONCLUSIONS: Cranial MRI images following emergency PCI revealed that 34.7% of the patients with ACS had aAIS that might be caused by manipulating the catheter or devices in the ascending aorta, micro-air bubble embolism during injection, or micro-thrombus embolism derived from the ACS lesions during the PCI procedure.


Assuntos
Síndrome Coronariana Aguda/complicações , Angioplastia Coronária com Balão/efeitos adversos , Acidente Vascular Cerebral/etiologia , Síndrome Coronariana Aguda/terapia , Idoso , Estudos de Casos e Controles , Cateterismo/efeitos adversos , Vasos Coronários , Embolia Aérea/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Tromboembolia/complicações
16.
Circ J ; 70(12): 1598-601, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17127806

RESUMO

BACKGROUND: Previous reports indicate that D-dimer testing (DT) for acute aortic dissection (AAD) has a sensitivity of 100%, but each study comprised less than 30 patients. The aim of this study was to evaluate the positive rate and factors related to the results of DT for AAD in a larger population. METHODS AND RESULTS: DT (cutoff; upper normal limit) was performed for 113 consecutive AAD patients within 24 h of symptom onset. In total, 104 (92%) patients exhibited positive DT. The positive rate of DT showed a low tendency in patients aged less than 70 years and for a time interval from symptom onset to admission within 120 min, and there were significant differences between those with and without a thrombosed false lumen (TFL) (86.4% (n=59) vs 98.1% (n=54), p=0.033), complete TFL (excluding patients with ulcer-like projection (ULP) from those with a TFL) (81.1% (n=37) vs 97.4% (n=76), p=0.005) and length score (1 (n=28); 78.6%, 2 (n=40); 95.0%, 3 (n=45); 97.8%, p=0.005). Multivariate analysis demonstrated age (odds ratio =1.164, p=0.013), complete TFL (0.048, 0.030) and length score (6.271, 0.033) as independent factors. CONCLUSIONS: Physicians should be aware that younger patients with short dissection length and a TFL without ULP are liable to have false-negative DT results.


Assuntos
Antifibrinolíticos , Aorta/patologia , Doenças da Aorta/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/patologia , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Circ J ; 70(7): 827-31, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16799233

RESUMO

BACKGROUND: Public access defibrillation has been introduced to improve the outcome of patients experiencing out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the best location for automated external defibrillators (AED). METHODS AND RESULTS: All patients who were resuscitated after OHCA by emergency medical technicians in Takatsuki City over 6 years were enrolled. The annual incidence of OHCA and the number of 1-year survivors with good neurological outcome in each of 21 sub-location categories were investigated, as well as the ratio of ventricular fibrillation (VF) as the initial rhythm to the total OHCA in each of 5 location categories. In total, there were 1,112 patients with OHCA, 62 (5.6%) with VF and 14 (1.3%) with good neurological outcome. The annual incidence of cardiac arrest (CA) per site was the highest in railway stations (0.3000), followed by hospitals (0.1802), homes for the aged (0.1115), playgrounds (0.0769) and golf courses (0.0667). However, none of the patients experiencing CA at railway stations, homes for the aged and golf courses had a good neurological outcome. The ratio of VF to total CA was the highest in the workplace (35.3%). CONCLUSIONS: The 6 locations, including workplace, are recommended as appropriate locations for AED.


Assuntos
Área Programática de Saúde , Desfibriladores , Serviços Médicos de Emergência , Parada Cardíaca/terapia , Feminino , Hospitais , Humanos , Japão , Masculino , Estudos Retrospectivos
19.
Circ J ; 69(8): 958-61, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16041166

RESUMO

BACKGROUND: Patients with aortic dissection (AD) often demonstrate positive heart-type fatty acid-binding protein (H-FABP), but its significance is unclear. METHODS AND RESULTS: In 63 of 64 consecutive AD patients, the serum H-FABP concentration was measured and the H-FABP positive rate calculated (cutoff value: 6.2 ng/ml) for each of following factors: (1) with or without dissection of the ascending aorta; and (2) a thrombosed false lumen; (3) length score; (4) presence of shock; (5) malperfusion of limbs; (6) ST elevation and/or depression on electrocardiogram; and (7) renal dysfunction. In total 36 AD patients had a positive H-FABP test. Statistically significant differences in the H-FABP positive rate were observed between those with and without ascending AD (76.7% vs 39.4%, p = 0.003), and in the length score (p < 0.001). Multivariate logistic regression test demonstrated that the most significant factor was the length score (odds ratio: 2.239 (95% confidence interval: 1.119-4.481), p = 0.023). Moreover, a significant correlation was observed between length score and absolute H-FABP value (r = 0.420, p = 0.001). CONCLUSIONS: In patients with AD, an increased serum H-FABP concentration is caused by the protein being released not only from the cardiac muscle but also from skeletal muscle, or possibly the aortic wall. Physicians using H-FABP for detection of myocardial injury need to be aware that patients with a long or ascending AD will show an elevation of H-FABP.


Assuntos
Ruptura Aórtica/sangue , Proteínas de Transporte/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/fisiopatologia , Ruptura Aórtica/patologia , Biomarcadores/sangue , Proteínas de Ligação a Ácido Graxo , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes
20.
Circ J ; 69(6): 677-82, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15914945

RESUMO

BACKGROUND: It is important to rapidly distinguish patients with acute aortic dissection of the ascending aorta (AADa) from those with acute myocardial infarction (AMI), because minimizing the time to initiation of reperfusion therapy leads to maximum benefits for AMI and erroneous reperfusion therapy for AADa can produce harmful outcomes. The aim of this study was to find a simple test to distinguish such patients. METHODS AND RESULTS: Data were collected from 29 consecutive patients with AADa and 49 consecutive patients with AMI who were admitted within 4 h of the onset of symptoms. The D-dimer concentration and the ratio of the maximum upper mediastinal diameter to the maximum thoracic diameter on plain chest radiograph (M-ratio) in the emergency room were studied retrospectively. Setting the cutoff values of the D-dimer concentration and the M-ratio to 0.8 or 0.9 microg/ml and 0.309, respectively, gave a sensitivity of 93.1% and 93.1% for AADa, respectively, and a sensitivity of 91.8% and 85.7% for AMI, respectively. CONCLUSIONS: The D-dimer value and the M-ratio, with appropriate cutoff values, have potential as tests that can be routinely used to exclude AADa patients from patients diagnosed with AMI prior to reperfusion therapy.


Assuntos
Aneurisma da Aorta Torácica/sangue , Aneurisma da Aorta Torácica/diagnóstico por imagem , Dissecção Aórtica/sangue , Dissecção Aórtica/diagnóstico por imagem , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico por imagem , Idoso , Biomarcadores/análise , Serviços Médicos de Emergência , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radiografia
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