Association between inflammation in acute phase and early onset pneumonia in patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation.

BACKGROUND: Early onset pneumonia (EOP) in patients with cardiac arrest treated with targeted temperature management is a recently debated issue. We assessed the association between C-reactive protein (CRP) levels and development of EOP in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). METHODS AND RESULTS: We reviewed the data of all patients admitted to our hospital after out-of-hospital cardiac arrest treated with ECPR between April 2006 and April 2019 who survived for at least 48 h. We collected demographic data, cardiac arrest characteristics, prophylactic antibiotic use, and neurologic outcomes. Diagnosis of EOP was made based on clinical, radiological, and microbiological criteria. The primary endpoint was the association between the incidence of EOP and CRP levels from day 1 to day 4. A total of 55 patients were included, of which 20 developed EOP. CRP levels on days 3 and 4 were significantly elevated in patients who developed EOP (13.1 [11.8-21.1] mg/dL versus 11.6 [7.4-15.2] mg/dL, P = 0.005; and 19.0 [16.9-27.1] mg/dL versus 14.7 [7.4-21.2] mg/dL, P = 0.019, respectively). In the multivariable logistic regression model, the CRP level on day 3 was significantly associated with the development of EOP (odds ratio 1.22; 95% confidence interval 1.06-1.41; P = 0.001). CONCLUSIONS: Increased inflammation in acute phase was associated with development of EOP in patients treated with ECPR.

Bidirectional ventricular tachycardia induced by caffeine poisoning.

Bidirectional ventricular tachycardia (BVT) is a tachyarrhythmia characterized by 180-degree beat-to-beat alteration in the QRS axis. BVT is traditionally known as an electrocardiography (ECG) finding pathognomonic of digitalis poisoning and a hallmark of catecholamine-induced ventricular tachycardia. Apart from digitalis poisoning, aconitine poisoning is the only reported cause of poisoning-related BVT, and no report of caffeine-poisoning-related BVT is as yet available. A-27-year-old woman was transported to hospital with cardiac arrest from ventricular fibrillation after taking a massive dose of a caffeine-containing supplement (corresponding to 6 g of caffeine) 6 h before presentation. Return of spontaneous circulation (ROSC) was achieved by defibrillation. She developed BVT after ROSC. Hemodialysis was performed to remove the causative drug from the blood, with subsequent resolution of BVT and hemodynamic stabilization. At presentation, she had a blood caffeine concentration of 232 µg/mL. A suggested mechanism of development of BVT is that increased intracellular calcium concentration causes delayed afterdepolarization, which induces alternate occurrence of triggered activities within different His-Purkinje fibers, and thereby produces characteristic ECG findings. Caffeine acts on the ryanodine receptor to promote calcium release from the sarcoplasmic reticulum, and thus can induce BVT via the same mechanism. Caffeine poisoning can be treated by dialysis. In cases of BVT induced by caffeine poisoning, hemodynamic stabilization can be achieved by emergency dialysis.

Synthesis and Characterization of Alkoxide-Bridged Heterometallic Clusters of Cerium and Copper.

We prepared alkoxide-bridged heterometallic clusters of cerium and copper by the complexation of two metal alkoxides: treatment of Ce(OtBu)4 with [Cu(OtBu)]4 in a 1:1 metal ratio produced an alkoxide-bridged tetranuclear cluster, Ce2Cu2(OtBu)10 (1). Upon adding 4-substituted pyridine derivatives to complex 1, trinuclear clusters, Ce2Cu(OtBu)9(L) (2a: L = DMAP (4-dimethylaminopyridine); 2b: L = BPY (4,4'-bipyridine)), were obtained along with the release of 0.25 equiv of [Cu(OtBu)]4, in which a three-coordinated copper center was involved. In contrast, reaction of 1 with 4 equiv of 2,6-dimethylphenylisocyanide (XylNC) and 0.5 equiv of [Cu(OtBu)]4 resulted in the selective formation of CeCu2(OtBu)6(CNXyl)2 (3). In addition, Ce2K(OtBu)9 was used for complexation with CuCl2 by salt-elimination, giving Ce2CuCl(OtBu)9 (4) including a five-coordinated copper center. These complexes 1-4 were characterized by crystal structure determination as well as cyclic voltammetry of 1, 2a, and 4. The cyclic voltammogram of 4 in CH2Cl2 and THF suggested that reorganization of the coordination sphere around the copper center was observed for 4 during the Cu(I/II) redox processes assisted by the coordination of THF.

Pneumonia and Extracorporeal Cardiopulmonary Resuscitation Followed by Targeted Temperature Management in Patients With Out-of-Hospital Cardiac Arrest　- Retrospective Cohort Study.

Background: We examined the association between initiation of extracorporeal cardiopulmonary resuscitation (ECPR) and the incidence of infectious complications, such as pneumonia, sepsis, and bacteremia, after out-of-hospital cardiac arrest (OHCA) in patients who received targeted temperature management (TTM). Methods and Results: This retrospective study used data from hospital medical records of patients with OHCA treated with TTM who had been admitted to St. Luke's International Hospital between April 2006 and December 2018. The primary endpoint was the association between the type of CPR and the incidence of early onset pneumonia in the intensive care unit (ICU; between 48 h and 7 days of hospitalization). Univariate and multivariate logistic regression analyses were performed for the primary endpoints. After applying the inclusion/exclusion criteria, 254 patients were included in the analyses; of these, 52 were enrolled in the ECPR group, and 202 were enrolled in the CCPR group. Median age was 58 years, 88.5% were male, prophylactic antibiotics were used in 80.3%, and favorable neurological outcomes were observed in 51.9%. On multivariate analysis, ECPR (odds ratio [OR], 2.78; 95% CI: 1.16-6.66; P=0.037) was significantly associated with the development of early onset pneumonia. Conclusions: ECPR was an independent predictor of pneumonia after OHCA in patients who received TTM.

Cardiac arrest from acute myocardial infarction complicated with sodium-glucose cotransporter 2 inhibitor-associated ketoacidosis.

Euglycemic diabetic ketoacidosis (DKA) has been recognized as a potentially fatal complication related to sodium-glucose cotransporter 2 (SGLT2) inhibitors. Herein, we report a patient of out-of-hospital cardiac arrest, with an initial cardiac rhythm of ventricular fibrillation, who was subsequently diagnosed with acute myocardial infarction, complicated with SGLT2 inhibitor-associated euglycemic DKA. The patient survived and achieved nearly full functional recovery. This report calls for increased attention to SGLT2 inhibitors' fatal complications, as well as their proper use. .