Author Archives: administrare

Out-of-Hospital Cardiac Arrest in Acute Myocardial Infarction and STEMI Networks

Theodora Benedek1*, Mariann Gyöngyösi2

1 University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Medical University of Vienna, Austria

DOI: 10.1515/jccm-2016-0007

Out-of-hospital cardiac arrest (OHCA) remains associated with a poor prognosis, with a survival rate of approximately 10% [1]. Only 40% of patients presenting with OHCA are successfully resuscitated, and only 25% of them survive to hospital discharge [1].
In many cases of OHCA associated with acute myocardial infarction, the cardiac arrest is caused by ventricular fibrillation, occurring during the first hours after the onset of symptoms, and before the patient being admitted to hospital [2]. In these critical cases, implementation of specific protocols and dedicated networks are crucial for providing effective advanced cardiac life support.
Several treatment modalities have been proposed to improve outcomes in the post-resuscitation period. One such measure is induced therapeutic hypothermia, consisting of administering cooling infusions to cool the patient down to 32-34⁰C, and maintaining this for 12-24 hours. Evidence shows that when initiated promptly, cooling improves neurological outcomes in survivors of OHCA [3,4]. However, there is no clear evidence that hypothermia would lead to a significant reduction in mortality in these patients. Current guidelines recommend early therapeutic hypothermia as a class Ib indication, in the post-resuscitation phase, after cardiac arrest in patients who are comatose or deeply sedated [2]. [More]

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Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An Overview

Endre Zima

Semmelweis University, Heart and Vascular Center, Budapest, Hungary

DOI: 10.1515/jccm-2015-0031

A satisfactory neurologic outcome is the key factor for survival in patients with sudden cardiac death (SCD), however this is highly dependent on the haemodynamic status. Short term cardiopulmonary resuscitation and regained consciousness on the return of spontaneous circulation (ROSC) is indicative of a better prognosis. The evaluation and treatment of SCD triggering factors and of underlying acute and chronic diseases will facilitate prevention and lower the risk of cardiac arrest. Long term CPR and a prolonged unconscious status after ROSC, in the Intensive Care Units or Coronary Care Units, indicates the need for specific treatment and supportive therapy including efforts to prevent hyperthermia. The prognosis of these patients is unpredictable within the first seventy two hours, due to unknown responses to therapeutic management and the lack of specific prognostic factors. Patients in these circumstances require the highest level of intensive care and aetiology driven treatment without any delay, independently of their coma state. Current guidelines sugest the use of multiple procedures in arriving at a diagnosis and prognosis of these critical cases.

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Ventricular Septal Rupture – A Critical Condition as a Complication of Acute Myocardial Infarction

Martin Novak*, Ota Hlinomaz, Ladislav Groch, Michal Rezek, Jiri Semenka, Jiri Sikora, Jan Sitar

International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic

DOI: 10.1515/jccm-2015-0030

Ventricular septal rupture is a potentially fatal complication of acute myocardial infarction. The key to management of this critical condition is an aggressive approach to haemodynamic stabilization and surgical closure of the rupture. Where there is a small rupture and the patient is in a haemodynamically stable condition, surgery can be delayed with the prospect of achieving better perioperative results. However, in unstable critically ill patients either immediate surgery or extracorporeal membranous oxygenation support and delayed surgery is indicated. In some patients, trans-catheter closure may be considered as an alternative to surgery.

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Dual Role of Angiopoietine II in the Complex Management of Critically Ill Patients with Sepsis

Monica Marton-Popovici

Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington, USA

DOI: 10.1515/jccm-2015-0029

I read with great interest the article entitled “The role of Angiopoietine-2 in the diagnosis and prognosis of sepsis”, published by Szederjesi et al in the issue no.1/2015 of JCCM journal [1]. As the authors pointed out, the  prognosis of patients with sepsis is highly dependent on the early establishment of a proper diagnosis and on the early initiation of the adequate therapy. Therefore, identification of new biomarkers characterising this critically ill condition can be considered extremely important for a better understanding of this condition, leading to a more rapid and accurate diagnostic. The study identified angiopoietine-2 (ANG-2) as such a new biomarker characterising septic shock, demonstrating a good correlation between ANG-2 levels, duration of stay in the intensive care unit and the most widely used ICU mortality prediction scores. At the same time, the study showed a good sensitivity and specificity of this biomarker for diagnosis of sepsis and the authors should be congratulated for their results. [More]

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Delayed Recovery from General Anaesthesia: A Post-operative Diagnostic Dilemma and Implications of ICU Management of Serotonin Toxicity. Case report

Asha Naik1, Cristobal Rincon-Aznar2

1 West Suffolk NHS Foundation Trust, United Kingdom
2 Mediclinic Dubai Mall, Dubai, United Arab Emirates

DOI: 10.1515/jccm-2015-0026

We report a case of delayed recovery from general anesthesia following a routine parathyroidectomy. Our objectives are to describe the process of establishing a differential diagnosis and subsequent management of a patient presenting with atypical neurological signs from an unknown etiology and to increase awareness about the potential for serotonin syndrome and neurotoxicity due to known interactions between methylene blue and selective serotonin-noradrenaline re-uptake inhibitors. ICU management of Serotonin Toxicity is briefly described.

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Cardiac Arrhythmias in a Septic ICU Population: A Review

Andrei Schwartz, Evgeni Brotfain*, Leonid Koyfman, Moti Klein

Department of Anesthesiology and Critical Care, General Intensive Care Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel

DOI: 10.1515/jccm-2015-0027

Progressive cardiovascular deterioration plays a central role in the pathogenesis of multiple organ failure (MOF) caused by sepsis. Evidence of various cardiac arrhythmias in septic patients has been reported in many published studies. In the critically ill septic patients, compared to non-septic patients, new onset atrial fibrillation episodes are associated with high mortality rates and poor outcomes, amongst others being new episodes of stroke, heart failure and long vasopressor usage. The potential mechanisms of the development of new cardiac arrhythmias in sepsis are complex and poorly understood. Cardiac arrhythmias in critically ill septic patients are most likely to be an indicator of the severity of pre-existing critical illness.

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Invasive Candida Infections in the ICU: Diagnosis and Therapy

Péter Hankovszky, Domonkos Trásy, Nándor Öveges, Zsolt Molnár*

Department of Anaesthesiology and Intensive Therapy, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary

DOI: 10.1515/jccm-2015-0025

Invasive fungal infections have become a serious problem in the critically ill. One of the main reasons is the development of an immunocompromised condition. The most frequently found pathogens are Candida species. In order to provide adequate treatment, understanding this potentially life-threatening infection is mandatory. The aim of this summary is to view Candida infections from a different perspective and to give an overview on epidemiology, the range of pathophysiology from colonization to the invasive infections, and its impact on mortality. New therapeutic options will also be discussed and how these relate to current guidelines. Finally, the key issue of the choice of antifungal agents will be evaluated.

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The Significance of Cardiac Arrhythmias in Septic ICU Patients

Daniela Ionescu

Department of Anesthesia and Intensive Care, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania; Outcome Research Consortium, Cleveland, USA

DOI: 10.1515/jccm-2015-0028

The review article published in this issue by Schwartz A et al [1] draws attention to the importance of cardiac arrhythmias and especially that of new-onset atrial fibrillation (AF) and the clinical outcome of septic patients. The incidence of this phenomenon varies in different reports, from 5.8% [2] to 31-40% [3-4].
Causes are numerous and different mechanisms have been described in the literature and by the authors of the review. Endotoxin induces tachycardia, increases the cardiac index, and reduces blood pressure and systemic vascular resistance without change in stroke volume [5]. Fluid administration results in a decrease in left ventricular ejection fraction and an increase in ventricular volumes even more than before the administration of fluid therapy [5].
An increased inflammatory response also plays an important role in pathogenesis of cardiac arrhythmias and dysfunction in septic patients. Increased plasma levels of C-reactive protein, IL-6 and TNF-α may contribute to the onset of AF in septic patients [1,6]. [More]

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