Phosphodiesterase-5 inhibition improves macrocirculation and microcirculation during cardiopulmonary resuscitation Junyuan Wu, Chunsheng Li, Wei Yuan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.033
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: October 2 2015
x This study is to clarify whether sildenafil, which is a selective inhibitor of the isoform 5 of the enzyme phosphodiesterase, improves macrocirculation or/and microcirculation during ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) so as to improve outcomes of resuscitation.
Resuscitation from hemorrhagic shock using polymerized hemoglobin compared to blood Daniel Ortiz, Marcelo Barros, Su Yan, Pedro Cabrales
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.045
The American Journal of Emergency Medicine , Vol. 32 , Issue 3 ,
Published online: December 9 2013
x The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)–based oxygen (O2 ) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure's function, administration, and adverse effects compared to blood.
Cerebral oximetry and cerebral blood flow monitoring in 2 pediatric survivors with out-of-hospital cardiac arrest Thomas Abramo, Nitin Aggarwal, Ian Kane, Kristen Crossman, Mark Meredith
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.039
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 25 2013
x In pediatric out-of-hospital cardiac arrest (POHCA), cardiovascular monitoring tools have improved resuscitative endeavors and cardiovascular outcomes but with still poor neurologic outcomes. Regarding cardiac arrest in patients with congenital heart disease during surgery, the application of cerebral oximetry with blood volume index (BVI) during the resuscitation has shown significant results and prognostic significance. We present 2 POHCA patients who had cerebral oximetry with BVI monitoring during their arrest and postarrest phase in the emergency department and its potential prognostic aspect.
A new site for venous access: superficial veins of portal collateral circulation Jean Turc, Laurent Gergelé, Rachid Attof, Nicolas Mottard, Michel Bérend, Jean-Stéphane David
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.027
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 15 2010
x In case of failure of peripheral vascular access, classical alternatives are central venous or intraosseous access. We report a new site of vascular access necessitating no specific material. A 53-year-old patient with cirrhosis-induced coagulopathy, portal hypertension, and collateral abdominal portosystemic circulation required parenteral antibiotherapy. After failure of peripheral vein catheterization, he was addressed to our resuscitation room for central venous access. To avoid the risks associated with this invasive procedure, we chose an alternative approach.
LUCAS 2TM device, compression depth, and the 2010 cardiopulmonary resuscitation guidelines Kovid Trivedi, Vesna Borovnik-Lesjak, Raúl J. Gazmuri
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.007
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 20 2013
x The 2010 guidelines for cardiopulmonary resuscitation recommends that the chest be compressed at least 5 cm, with evidence that depths exceeding 5 cm may further aid resuscitation. The current piston-based mechanical device LUCAS 2TM is programmed to deliver a compression depth of 5 cm. We report 2 cases in which the LUCAS 2TM device failed to generate physiological surrogates of blood flow (ie, end-tidal carbon dioxide tension and aortic diastolic blood pressure) at levels indicative of effective chest compressions.
The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults Soo Hoon Lee, Dong Hoon Kim, Tae-Sin Kang, Changwoo Kang, Jin Hee Jeong, Seong Chun Kim, Dong Seob Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.034
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: April 24 2015
x This study was conducted to evaluate the appropriateness of the chest compression (CC) depth recommended in the current guidelines and simulated external CCs, and to characterize the optimal CC depth for an adult by body mass index (BMI).
Arterial to end-tidal CO2 pressure gradient: a bedside parameter to monitor patients with massive pulmonary embolism Chan-il Park, Karim Bendjelid, Robert F. Bonvini
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.031
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Massive pulmonary embolism (PE) is a life-threatening condition that mandates urgent pulmonary reperfusion. To adequately monitor hemodynamic of these highly unstable patients remains challenging because there is no validated correlation between the arterial oxygen level, the severity of the PE, and the efficacy of the adopted reperfusion therapy. We report on 2 patients presenting with massive PE, who were monitored measuring simultaneously the cardiac output and the pressure gradient between arterial and end-tidal CO2 .
Use of extracorporeal membrane oxygenation in severe traumatic lung injury with respiratory failure Shih-Chi Wu, William Tzu-Liang Chen, Hui-Han Lin, Chih-Yuan Fu, Yu-Chun Wang, Hung-Chieh Lo, Han-Tsung Cheng, Chia-Wei Tzeng
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: February 7 2015
x The use of extracorporeal membrane oxygenation (ECMO) in managing acute respiratory distress syndrome had been accepted. Severe lung injury with respiratory failure is often encountered in trauma patients. We report our experience with the use of ECMO in severe traumatic lung injury.
Combined intraaortic balloon counterpulsation and extracorporeal membrane oxygenation in 2 patients with fulminant myocarditis Weihang Hu, Changwen Liu, Lan Chen, Wei Hu, Jun Lu, Yin Zhu, Jianrong Wang, Bingwei Liu
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 29 2014
x Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective treatment for fulminant myocarditis (FM). However, VA-ECMO has a limited ability to facilitate left ventricular unloading. Therefore, increased afterload is still a significant concern, especially for those with diffuse myocardial damage and serious left ventricular dysfunction. To our knowledge, there is no report concerning the use of these therapies to treat FM in China. This study investigates the efficacy of using intraaortic balloon counterpulsation to facilitate left ventricular unloading in patients treated with VA-ECMO.
A novel hands-free carotid ultrasound detects low-flow cardiac output in a swine model of pulseless electrical activity arrest Todd M. Larabee, Charles M. Little, Balasundar I. Raju, Eric Cohen-Solal, Ramon Erkamp, Scott Wuthrich, John Petruzzello, Michael Nakagawa, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.05.013
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: August 16 2010
x To determine if a hands-free, noninvasive Doppler ultrasound device can reliably detect low-flow cardiac output by measuring carotid artery blood flow velocities. We compared the ability of observers to detect carotid artery flow velocity differences between pseudo-pulseless electrical activity (PEA) and true-PEA cardiac arrest.
The critical need for further research and development of abdominal compressions cardiopulmonary resuscitation Eric M. Rottenberg
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.024
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: May 23 2014
x A recent editorial on the science of basic life support (BLS) education acknowledges that, despite nearly 4 decades of public instruction in cardiopulmonary resuscitation (CPR) classes, most people who complete CPR training still do not perform effective basic CPR even immediately after training [1]. But still supports the theory that survival rates for unexpected cardiac arrest depend not only on the quality of the education given to potential caregivers but also on the validity of treatment guidelines and a well-functioning chain of survival [2].
Median arcuate ligament syndrome presenting as hemorrhagic shock Yosuke Matsumura, Taka-aki Nakada, Yoshiro Kobe, Noriyuki Hattori, Shigeto Oda
DOI: http://dx.doi.org/10.1016/j.ajem.2013.02.030
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 20 2013
x The major symptoms of median arcuate ligament syndrome, celiac axis stenosis, or occlusion compressed by the median arcuate ligament include eating-associated abdominal pain and weight loss. Because celiac stenosis increases retrograde collateral blood flow from the superior mesenteric artery to the celiac artery via the pancreaticoduodenal arcade, a pancreaticoduodenal artery aneurysm could occur at a low incidence rate. Rupture of the pancreaticoduodenal artery aneurysm and hemorrhagic shock are rare.
Epinephrine, vasopressin, and nitroglycerin improve neurologic outcome in porcine asphyxial cardiac arrest Giolanda Varvarousi, Sotirios Goulas, Georgios Agrogiannis, Nikolaos Valsamakis, Dimitrios Iliopoulos, Despina Perrea, Christodoulos Stefanadis, Lila Papadimitriou, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.01.008
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: March 2 2012
x The aim of the present study was to assess whether the combination of epinephrine, vasopressin, and nitroglycerin would improve initial resuscitation success, 24-hour survival, and neurologic outcome compared with epinephrine alone in a swine model of asphyxial cardiac arrest (CA).
Short series of upper limb acute arterial occlusions in 4 different etiologies and review of literature Selcuk Coskun, Lutfi Soylu, Pınar Koksal Coskun, Murat Bayazıt
DOI: http://dx.doi.org/10.1016/j.ajem.2013.06.041
The American Journal of Emergency Medicine , Vol. 31 , Issue 12 ,
Published online: September 23 2013
x Upper limb acute arterial occlusions are uncommon, and when compared with lower limb occlusions, only a few cases have been reported. Although atrial fibrillation is the most common cause, many conditions may lead to ischemia. In this article, 8 cases of upper limb arterial ischemia due to 4 different etiologies were reported (7 brachial, 1 axillary), and the literature was reviewed.
A new method to detect cerebral blood flow waveform in synchrony with chest compression by near-infrared spectroscopy during CPR Yasuaki Koyama, Takafumi Wada, Brandon D. Lohman, Yuka Takamatsu, Junichi Matsumoto, Shigeki Fujitani, Yasuhiko Taira
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: August 21 2013
x The objective of the study is to demonstrate the utility of near-infrared spectroscopy (NIRS) in evaluating chest compression (CC) quality in cardiac arrest (CA) patients as well as determine its prognosis predictive value.
Small-volume resuscitation from hemorrhagic shock with polymerized human serum albumin Catalina Messmer, Ozlem Yalcin, Andre F. Palmer, Pedro Cabrales
DOI: http://dx.doi.org/10.1016/j.ajem.2011.09.018
The American Journal of Emergency Medicine , Vol. 30 , Issue 8 ,
Published online: November 21 2011
x Human serum albumin (HSA) is used as a plasma expander; however, albumin is readily eliminated from the intravascular space. The objective of this study was to establish the effects of various-sized polymerized HSAs (PolyHSAs) during small-volume resuscitation from hemorrhagic shock on systemic parameters, microvascular hemodynamics, and functional capillary density in the hamster window chamber model. Polymerized HSA size was controlled by varying the cross-link density (ie, molar ratio of glutaraldehyde to HSA).
Cerebral oximetry with blood volume index in asystolic pediatric cerebrospinal fluid malfunctioning shunt patients Thomas J. Abramo, Mark Meredith, Mathew Jaeger, Bradford Schneider, Holli Bagwell, Eleym Ocal, Gregory Albert
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.007
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 17 2014
x Pediatric cerebrospinal fluid shunt malfunctions can present with varying complaints. The primary cause is elevated intracranial pressure (ICP). Malfunctioning sites are the proximal or distal sites [1-4]. A rare presenting complaint is cardiac arrest. Immediate ICP reduction is the only reversible option for this type of cardiac arrest.
Multimodality diagnosis and surgical management of prosthetic valve endocarditis complicated with perivalvular abscess formation Mahmut Yesin, Macit Kalçık, Mustafa Ozan Gürsoy, Süleyman Karakoyun, Emrah Bayam, Mehmet Altuğ Tuncer, Mehmet Özkan
DOI: http://dx.doi.org/10.1016/j.ajem.2015.03.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: March 19 2015
x Periannular extension of infection is a rare but potentially fatal complication of infective endocarditis. The accurate detection and delineation of periannular complications are crucial in patient management, which may also provide guidance for surgical interventions. Potential complications from a periannular extension of infective endocarditis include periannular abscess, pseudo-aneurysm formation, and subsequent development of aortocavitary fistula. Here, we present a case of a 46-year-old man with prosthetic aortic valve endocarditis complicated with perivalvular abscess formation that was managed with aortic homograft implantation.
Role of levosimendan in the management of subarachnoid hemorrhage Giolanda Varvarousi, Theodoros Xanthos, Pavlina Sarafidou, Ellisavet Katsioula, Marianthi Georgiadou, Maria Eforakopoulou, Hlias Pavlou
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.024
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 16 2015
x Aneurysmal subarachnoid hemorrhage (aSAH) is one of the leading causes of neurologic disability accounting for dismal long term survival rates. aSAH leads to a sudden increase in intracranial pressure and a massive sympathetic discharge. Excessive sympathetic stimulation leads to catecholamine mediated myocardial dysfunction and hemodynamic instability which may critically hamper brain perfusion and oxygenation. In the setting of acute aSAH, administration of vasoactive drugs aims at stabilizing impaired hemodynamics.
Therapeutic hypothermia induction via an esophageal route—a computer simulation Vytautas Vaicys, Antone Eason, Jay D. Schieber, Erik B. Kulstad
DOI: http://dx.doi.org/10.1016/j.ajem.2011.04.026
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: June 13 2011
x Mild therapeutic hypothermia has been shown to improve outcomes after adult cardiac arrest but remains underused. Development of easier methods than currently exist to induce therapeutic hypothermia may help increase use of this treatment. We developed a mathematical model to evaluate the potential to induce mild therapeutic hypothermia through the esophagus.
