The link between carotid artery stenosis and outcomes in patients with refractory out-of-hospital cardiac arrest.

BACKGROUND: Mortality of out-of-hospital cardiac arrest (OHCA) remains high. Extracorporeal cardiopulmonary resuscitation (ECPR) has revolutionized OHCA treatment, but our understanding of the ECPR responder's clinical profile is incomplete. Carotid artery stenosis (CAS) is a well-established cardiovascular disease risk factor. The impact of CAS on OHCA outcomes remains unelucidated. OBJECTIVE: To assess whether CAS burden affects the outcomes of OHCA patients treated with ECPR. METHODS: This study included patients with OHCA admitted for ECPR consideration, who had carotid ultrasonography performed. A numeric scale was applied to the plaque to create a CAS burden numeric scale. The primary outcome of the study was survival at discharge, compared among the different degrees of CAS. Neurologically intact survival and surrogate markers of neurologic injury were the secondary study endpoints. To assess the independent effect of CAS burden on survival to hospital discharge, we conducted a logistic regression analysis. RESULTS: Between 2019 and 2023, carotid ultrasonography was performed on 163 patients who were admitted for refractory OHCA. CAS burden was equally distributed between the right and left carotid arteries. Logistic regression analysis indicated that the CAS burden was significantly associated with both overall and neurologically intact survival at discharge (p = 0.004). A linear relationship between the CAS burden and neuron-specific and S-100 levels was identified. Patients with normal carotids were significantly less likely to have encephalopathy on electroencephalograms. CONCLUSION: CAS burden independently predicts the risk for worse survival and neurologic outcomes in patients suffering refractory OHCA who are treated with ECPR.

Nefazodone: single versus twice daily dose.

This pilot study involved six men with major depression treated with nefazodone dosed either twice/day or once/day at bedtime. Depression was rated before nefazodone therapy and at 4 weeks by the self-report version of the Hamilton Depression Rating Scale. A simple 10-cm visual analog side effect scale for daytime drowsiness was completed at the latter time. Dosages of nefazodone were at least 400 mg/day. The results suggest that nefazodone given once/day at bedtime may be as effective as the currently accepted twice/day regimen, with less daytime drowsiness.

Money as a tool to extinguish conditioned responses to cocaine in addicts.

Classical conditioning principles offer a nondrug way to treat cocaine dependence. Eleven male subjects with the primary diagnosis of cocaine dependence were placed into one of two groups. The experimental group was asked to handle $500 cash in a mock budgetary task. The control group was asked to just imagine handling and budgeting the money. The subjects rated their craving-related feelings before and after each task. The experimental group showed significantly more craving after the money-handling task as compared to the control group, and the scores improved with time and as more tasks were completed. These data show that craving induced by handling cash is powerful and can be attenuated, at least on a short-term basis, using classical extinction procedures.

Daily cocaine craving in a 3-week inpatient treatment program.

Fifteen male veteran cocaine addicts took simple tests of cocaine craving, mood, energy, and perceived health status for 23 consecutive days during an inpatient treatment center. Results show they experienced very little cocaine craving or other symptomatology. Multiple regression analyses show that health rating alone was the best predictor of cocaine craving. These results question solely internal sources of craving and the oft-touted craving-depression connection. The study delineates further implications of the findings.