Predicting survival in out-of-hospital cardiac arrest patients undergoing targeted temperature management: The Polish Hypothermia Registry Risk Score.

BACKGROUND: Prompt reperfusion and post-resuscitation care, including targeted temperature management (TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict inhospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions. METHODS: Three hundred seventy-six OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariate logistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy. RESULTS: The mean age of the studied population was 59.2 ± 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 ± 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74. CONCLUSIONS: PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM.

[Catastrophic antiphospholipid syndrome complicated by cardiogenic shock - a case report]. / Katastroficzny zespól antyfosfolipidowy przebiegajacy ze wstrzasem kardiogennym - opis przypadku.

A case of a 29-year-old woman 18 days after delivery with catastrophic antiphospholipid syndrome secondary (CAPS) due to undiagnosed systemic lupus erythematosus, leading to cardiogenic shock is reported. Laboratory evaluation revealed increased anticardiolipin antibodies, lupus anticoagulant, antinuclear antibody and thrombocytopenia. Left ventricular ejection fraction was 20%, neurologic deficit and acute renal failure were also present. Cardiac involvement is common in CAPS, but cardiomyopathy due to microvascular thrombosis is rare. CAPS should be considered as a cause of acute heart failure in a women with systemic lupus erythematosus. In the presented case early therapy with anticoagulants, steroids, immunoglobulins and plasmaferesis was beneficial.

How to improve noninvasive coronary artery disease diagnostics in premenopausal women? The influence of menstrual cycle on ST depression, left ventricle contractility, and chest pain observed during exercise echocardiography in women with angina and normal coronary angiogram.

BACKGROUND: The aim was to assess the influence of menstrual cycle on results of exercise echocardiography and electrocardiography. METHODS: Premenopausal women (n=28) with regular monthly menses, presented typical angina, positive electrocardiogram (ECG) exercise stress test, and normal coronary angiogram were recruited. Exercise supine bicycle echocardiography with simultaneous recording of 12-lead ECG was performed once a week for 4 consecutive weeks. Occurrence of angina, time to angina, time to significant ST deviation, and segmental myocardial contractility were analyzed. Blood samples were drawn to estimate follicle-stimulating hormone, luteinizing hormone, beta-estradiol, progesterone concentration and confirm the position in menstrual cycle. In correlation analysis, linear and logistic regression were used as appropriate. Qualitative variables were categorized into quartiles in logistic regression analysis. RESULTS: Exercise ST depression was more frequently observed in both luteal phases (early luteal 78%, late luteal 86%) compared to the late follicular phase (50%, P<.05). Time to ST depression was significantly longer in late follicular phase compared to other phases. The rate of segmental exercise left ventricular hypokinesis was low and not significantly related to menstrual cycle. Using linear regression, significant positive correlation was found between estradiol-progesterone ratio and time to ST depression. Using multiple logistic regression, we confirmed that progesterone level is independent factor influencing the presence of ST depression. CONCLUSION: In women with typical angina and normal coronary angiogram, the position in menstrual cycle influences the ST depression but not myocardial contractility during exercise echocardiography.

[Monitoring of tracheal tube cuff pressure in patients treated in intensive therapy unit and intensive care units]. / Monitorowanie cisnienia w mankietach uszczelniajacych rurek intubacyjnych u chorych leczonych w oddziale intensywnej terapii i w oddzialach intensywnego nadzoru.

BACKGROUND AND AIM OF THE STUDY: Proper tracheal tube cuff pressure (CP) can diminish the risk of side effects. Excessive tracheal tube cuff pressure can cause ischaemic changes in the tracheal mucosa, decubitation, granuloma, rupture of a trachea, tracheo-oesophageal fistulae or tracheal stenosis. Too low CP is also undesirable, because it can increase the leakage of colonized subglottic secretions around the tracheal tube cuff, which is the risk factor of ventilatory associated pneumonia. Accidental extubation may also occur. The aim of the study was to find out if there are any differences in maintenance of the proper CP between the staff of intensive therapy unit (ITU) under the supervision of anaesthesiologists and staff of intensive care units (ICU) led by non-anaesthesiologists. MATERIALS AND METHODS: We measured the CP in 219 intubated patients. There were 107 patients hospitalized in ITU, under anaesthesiologists's surveillance, the other 112 patients in ICUs were supervised by non-anaesthesiologists. The patients were intubated with Portex Profile Soft-Seal Cuff and Mallinckrodt Hi-Lo with low-pressure and high-volume cuffs. The manometer PORTEX with the recommended range of CP 16-26 cm H2O (1.56-2.54 kPa). The teams were unaware that the audit was taking place. If the CP was out of range, it was corrected to the proper values. RESULTS AND CONCLUSIONS: The data analysis did not reveal any differences between values of CP in both groups of subjects. Over-inflation was more frequent than under-inflation in both groups of patients. Regular measurement of tracheal cuff pressure was not a routine procedure in the controlled units.