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Mayo registry for telemetry efficacy in arrest study: An evaluation of the feasibility of the do not intubate code status. 梅奥注册中心在心脏骤停研究中的遥测疗效:评估不插管码状态的可行性。
Pub Date : 2016-12-01 Epub Date: 2017-12-06 DOI: 10.1080/17482941.2017.1408917
David Snipelisky, Adrian Dumitrascu, Jordan Ray, Archana Roy, Gautam Matcha, Dana Harris, Tyler Vadeboncoeur, Fred Kusumoto, M Caroline Burton

Introduction: Guidelines recommend discussing code status with patients on hospital admission. No study has evaluated the feasibility of a full code with do not intubate (DNI) status. Methods: A retrospective analysis of patients who experienced a cardiopulmonary arrest was performed between May 1, 2008 and June 20, 2014. A descriptive analysis was created based on whether patients required mechanical ventilatory support during the hospitalization and comparisons were made between both patient subsets. Results: A total of 239 patients were included. Almost all (n = 218, 91.2%) required intubation during the hospitalization. Over half (n = 117, 53.7%) were intubated on the same day as the cardiopulmonary arrest and 91 patients (41.7%) were intubated at the time of arrest. Comparisons between intubated and non-intubated patients showed little differences in clinical characteristics, except for a higher proportion of medical cardiac etiology for admission in patients who did not require intubation (n = 10, 47.6% versus n = 55, 25.2%; p = 0.18) and initial arrest rhythm of ventricular tachycardia/fibrillation (n = 8, 38.1% versus n = 50, 22.9%; = 0.37). No differences in 24-hour and posthospital survivals were present. Conclusion: Mechanical ventilatory support is commonly utilized in patients who experience a cardiopulmonary arrest. The DNI status may not be a feasible code status option for most patients.

导言:指南建议在入院时与患者讨论代码状态。没有研究评估了不插管(DNI)状态下完整代码的可行性。方法:回顾性分析2008年5月1日至2014年6月20日期间发生心肺骤停的患者。基于患者在住院期间是否需要机械通气支持进行描述性分析,并对两组患者进行比较。结果:共纳入239例患者。几乎所有患者(n = 218, 91.2%)在住院期间都需要插管。超过半数(117例,53.7%)患者在心肺骤停当天插管,91例(41.7%)患者在心肺骤停时插管。插管和非插管患者的临床特征比较差异不大,除了不需要插管的患者入院时医学心脏病因的比例更高(n = 10, 47.6% vs n = 55, 25.2%;P = 0.18)和室性心动过速/颤动的初始骤停节律(n = 8, 38.1% vs n = 50, 22.9%;p = 0.37)。24小时生存率和出院后生存率无差异。结论:机械通气支持常用于心肺骤停患者。对于大多数患者来说,DNI状态可能不是一个可行的代码状态选择。
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引用次数: 1
Acute pneumopericardium: when echocardiography is not enough. 急性心包:超声心动图不充分时。
Pub Date : 2016-12-01 Epub Date: 2018-02-16 DOI: 10.1080/17482941.2017.1363394
Manuel Oliveira-Santos, Elisabete Jorge, Rui Baptista Luís Leite, Rui Martins, João Calisto, Vítor Matos, Mariano Pego
A 46-year-old female with metastasized rectal adenocarcinoma complained of progressive exertional dyspnea. The physical exam was remarkable for low blood pressure (98/54 mmHg) and tachycardia (115 bpm). A severe pericardium effusion with right chambers’ collapse was identified, and the patient was submitted to echocardiography-guided pericardiocentesis by a subxiphoid approach, employing a handheld ultrasound device, with fluoroscopy available. The puncture was undertaken uneventfully, with prompt drainage of serous fluid (500 cc) through a 6Fr pigtail catheter paralleled by pericardial effusion reduction on echo. However, it was impossible to obtain an ultrasound window to visualize the heart at the end of the procedure. Diagnosis: Immediate fluoroscopy showed a pneumopericardium (image and video 1), which explained the imaging finding on transthoracic ultrasound. The air was instantly drained with a 50-cc syringe (video 2). The patient remained asymptomatic and the discharge chest radiography was normal. Pneumopericardium is a rare complication of pericardiocentesis, and we hypothesize that it was due to air leakage to the pericardial drainage system (1). Conservative management is reasonable in hemodinamically stable patients (2); however, we proceeded to aspiration as the catheter was in position. Fluoroscopy was crucial for this clinically inapparent diagnosis.
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引用次数: 0
A multi-hospital analysis of predictors of oral anticoagulation prescriptions for patients with actionable atrial fibrillation who attend the emergency department. 多家医院对急诊科可操作心房颤动患者口服抗凝处方预测因素的分析
Pub Date : 2016-12-01 Epub Date: 2017-11-29 DOI: 10.1080/17482941.2017.1406954
Joel A Scott-Herridge, Colette M Seifer, Ron Steigerwald, Glen Drobot, William F McIntyre

Atrial fibrillation (AF) is the most common arrhythmia and is associated with an increase in the risk of ischemic stroke. The risk of stroke can be significantly decreased by oral anticoagulation (OAC). Our objective was to characterize the filling of OAC prescriptions for patients with actionable AF (new or existing AF with an indication for OAC but not prescribed) and determine the prevalence and predictors of guideline-appropriate therapy at 30 days. This is a multi-hospital, retrospective cohort study of patients who visited the Emergency Department (ED) and had a discharge diagnosis of AF. Patient records were examined to identify demographics, risk factors, and prescription data. Predictors of filling a prescription at 30 days were analyzed. 788 patients with AF were reviewed. 257 patients had actionable AF. Forty one percent (104) had newly diagnosed AF. The mean CHADS2 score was 2 ± 1. At 30 days after discharge, 25.7% of patients filled a prescription for OAC therapy. Large numbers of patients attending the ED have actionable AF, but rates of guideline-directed OAC at thirty days are low. Only a prescription written by the ED physician (OR 9.89) and documentation of stroke risk stratification in the patients' chart (OR 4.09) were associated with the primary outcome.

心房颤动(AF)是最常见的心律失常,与缺血性中风的风险增加有关。口服抗凝剂(OAC)可显著降低卒中风险。我们的目的是表征可行动性房颤(新的或现有的房颤有OAC指征但未开处方)患者的OAC处方的填写情况,并确定30天内指南适当治疗的患病率和预测因素。这是一项多家医院的回顾性队列研究,研究对象是到急诊科(ED)就诊并出院诊断为房颤的患者。研究人员检查了患者记录,以确定人口统计学、危险因素和处方数据。分析了30天内配药的预测因素。回顾了788例房颤患者。257例患者为可行动性房颤,41%(104例)为新诊断房颤。CHADS2平均评分为2±1。出院后30天,25.7%的患者开处方接受OAC治疗。大量急诊科患者有可操作的房颤,但指南指导的30天房颤发生率很低。只有急诊科医生开具的处方(OR为9.89)和患者病历中卒中风险分层的记录(OR为4.09)与主要结局相关。
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引用次数: 4
Double guide double wrist 5F left coronary artery transradial percutaneous coronary intervention and the X-Kiss technique. 双导双腕5F左冠状动脉经桡动脉经皮冠状动脉介入治疗及X-Kiss技术。
Pub Date : 2016-09-01 Epub Date: 2017-11-08 DOI: 10.1080/17482941.2017.1369126
Dangoisse Vincent, Schroëder Erwin, Claude Hanet, Antoine Guédès, Pancholy Samir

Percutaneous coronary intervention for bifurcated anatomy, particularly at the proximal left coronary artery site, requires guide catheters (GC) of at least 6 french and preferably larger in diameter. We describe a new trans-radial approach more suitable for small artery size: the simultaneous use of both radial arteries for double cannulation of the LMCA with 5F GC: each GC will target either the LM/LAD or the LM/CX artery (or LM-LAD/LM-LAD-1st diagonal branch) stenoses. The technique successfully was applied to 5 cases. When the technique was used for distal left main coronary artery stenoses (3 cases), a special crogss-like configuration obtained when guide catheters, coronary wires and balloons kissed was observed.

经皮冠状动脉介入治疗分叉解剖,特别是在左冠状动脉近端部位,需要引导导管(GC)至少6法国,最好直径更大。我们描述了一种新的更适合小动脉尺寸的经桡动脉入路:同时使用两条桡动脉对LMCA进行5F GC双重插管:每条GC将针对LM/LAD或LM/CX动脉(或LM-LAD/LM-LAD-1斜支)狭窄。该技术成功应用于5例患者。应用该技术治疗左冠状动脉主干远端狭窄(3例)时,观察到导管、冠状动脉丝、气球吻合时形成特殊的十字状构型。
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引用次数: 3
Severe burns in a patient after out-of-hospital CPR. 院外心肺复苏术后严重烧伤患者。
Pub Date : 2016-09-01 Epub Date: 2017-10-25 DOI: 10.1080/17482941.2017.1382704
Nir Biterman, Arthur Kerner, Doron Aronson, Yaron BarLavie, Yehuda Ullmann, Michael Kapeliovich
ABSTRACT We present a case of a patient after prolonged cardio-pulmonary resuscitation on hot asphalt, who suffered from first and second degree burns which worsened during hospitalization. The patient was treated with therapeutic hypothermia. Possible effect of therapeutic hypothermia on the course of burns is discussed.
我们提出了一个病例的病人在热沥青长时间心肺复苏后,谁遭受了一、二度烧伤,并在住院期间恶化。患者接受治疗性低温治疗。讨论了治疗性低温对烧伤过程可能产生的影响。
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引用次数: 0
Demographic and clinical features of atrial myxomas: A case series analysis. 心房黏液瘤的人口学和临床特征:一个病例系列分析。
Pub Date : 2016-09-01 DOI: 10.1080/17482941.2017.1398827
Rafael Garcia-Carretero, Blanca Beamonte Vela, Gabriel Martínez-Quesada, Blanca San Jose Montano

Aim: Cardiac myxomas are uncommon tumors and have a wide clinical spectrum. Their diagnosis can therefore be elusive because symptoms are nonspecific and misleading. Our aim was to characterize and analyze the clinical findings in patients presenting with cardiac myxomas.

Methods: We conducted a retrospective, hospital-based case study using the electronic records of a Spanish general hospital, caring for a population of 155,000. Patients' data were collected for the period between 2000 and 2016. Demographic data and clinical features were analyzed.

Results: Our series included 22 patients over a 15-year period (annual incidence of 0.94 patients per 100,000 inhabitants). Men were predominant (68%) and the median age was 69 years. Cardiac (40.9%), systemic (27.3%), and neurological manifestations (13.6%) were the main clinical features. Left atrium (81.8%) was the predominant location. Surgical treatment was performed in all patients and the overall outcome was good in all cases.

Conclusions: Cardiac myxomas are uncommon, benign tumors, predominantly located in the left atrium and mainly affecting middle-aged and elderly male patients. Congestive heart failure, stroke, and systemic symptoms, although misleading and nonspecific, are the most frequent forms of clinical presentation.

目的:心脏黏液瘤是一种少见的肿瘤,临床表现广泛。因此,他们的诊断可能难以捉摸,因为症状是非特异性的和误导性的。我们的目的是描述和分析心脏黏液瘤患者的临床表现。方法:我们使用西班牙一家综合医院的电子记录进行了一项回顾性的、基于医院的案例研究,涉及155,000人。患者的数据是在2000年至2016年期间收集的。分析人口学资料和临床特征。结果:我们的研究包括22例患者,随访15年(年发病率为每10万居民0.94例)。男性居多(68%),中位年龄为69岁。主要临床表现为心脏(40.9%)、全身(27.3%)和神经系统(13.6%)。左心房为主要部位(81.8%)。所有患者均行手术治疗,总体预后良好。结论:心脏黏液瘤是一种少见的良性肿瘤,多发于左心房,多见于中老年男性。充血性心力衰竭,中风和全身症状,虽然误导和非特异性,是最常见的临床表现形式。
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引用次数: 8
Pregnant women with heart disease: Placental characteristics and their association with fetal adverse events. 患有心脏病的孕妇:胎盘特征及其与胎儿不良事件的关系
Pub Date : 2016-09-01 Epub Date: 2017-11-22 DOI: 10.1080/17482941.2017.1397699
Fabio V Lima, Paraskevi Koutrolou-Sotiropoulou, Puja B Parikh, Cecilia Avila, Javed Butler, Kathleen Stergiopoulos

Background: Pregnant women with heart disease (HD) have higher rates of adverse fetal outcomes. We describe placental pathologic characteristics and their association with fetal events.

Methods: In pregnant women, known HD were categorized into: (1) cardiomyopathy (CM) or (2) other HD (congenital, coronary, arrhythmia, or valvular). Outcomes were maternal major adverse cardiac events (MACE), fetal adverse clinical events (FACE), a composite of infant death, prematurity, underweight status, intracranial hemorrhage, and respiratory distress. Only pathologically reported placental analyses were included.

Results: We studied 86 pregnancies in women with CM and HD, with pathologic analyses on 35 CM and 52 HD placentas. CM placentas, compared with those with HD, were more likely to have ischemic changes (65.7% vs. 37%, p 0.008), demonstrate immaturity (62.90% vs. 10%, p < 0.001), and have a lower weight (p < 0.001), despite similar gestational age. CM was independently associated with increased risk for MACE (OR 7.38, 95%CI 2.20-24.76). Ischemic placental changes were associated with increased odds of FACE (OR 24.78, 95%CI 2.37-259.03).

Conclusions: Women with CM were more likely to have ischemic placentas, with lower placental and fetal weights, and evidence of immaturity compared with those with other forms of HD, and an increased odds of MACE.

背景:患有心脏病(HD)的孕妇有较高的不良胎儿结局发生率。我们描述胎盘病理特征及其与胎儿事件的关系。方法:在孕妇中,已知的HD分为:(1)心肌病(CM)或(2)其他HD(先天性,冠状动脉,心律失常或瓣膜性)。结果为母体主要不良心脏事件(MACE)、胎儿不良临床事件(FACE)、婴儿死亡、早产、体重不足、颅内出血和呼吸窘迫的综合结果。只包括病理报告的胎盘分析。结果:我们研究了86例CM和HD孕妇,对35例CM和52例HD胎盘进行了病理分析。与HD患者相比,CM胎盘更容易发生缺血性改变(65.7% vs. 37%, p 0.008),表现出不成熟(62.90% vs. 10%, p)。结论:与其他形式的HD患者相比,CM女性更容易出现缺血性胎盘,胎盘和胎儿体重更低,有不成熟的迹象,MACE的几率也更高。
{"title":"Pregnant women with heart disease: Placental characteristics and their association with fetal adverse events.","authors":"Fabio V Lima,&nbsp;Paraskevi Koutrolou-Sotiropoulou,&nbsp;Puja B Parikh,&nbsp;Cecilia Avila,&nbsp;Javed Butler,&nbsp;Kathleen Stergiopoulos","doi":"10.1080/17482941.2017.1397699","DOIUrl":"https://doi.org/10.1080/17482941.2017.1397699","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women with heart disease (HD) have higher rates of adverse fetal outcomes. We describe placental pathologic characteristics and their association with fetal events.</p><p><strong>Methods: </strong>In pregnant women, known HD were categorized into: (1) cardiomyopathy (CM) or (2) other HD (congenital, coronary, arrhythmia, or valvular). Outcomes were maternal major adverse cardiac events (MACE), fetal adverse clinical events (FACE), a composite of infant death, prematurity, underweight status, intracranial hemorrhage, and respiratory distress. Only pathologically reported placental analyses were included.</p><p><strong>Results: </strong>We studied 86 pregnancies in women with CM and HD, with pathologic analyses on 35 CM and 52 HD placentas. CM placentas, compared with those with HD, were more likely to have ischemic changes (65.7% vs. 37%, p 0.008), demonstrate immaturity (62.90% vs. 10%, p < 0.001), and have a lower weight (p < 0.001), despite similar gestational age. CM was independently associated with increased risk for MACE (OR 7.38, 95%CI 2.20-24.76). Ischemic placental changes were associated with increased odds of FACE (OR 24.78, 95%CI 2.37-259.03).</p><p><strong>Conclusions: </strong>Women with CM were more likely to have ischemic placentas, with lower placental and fetal weights, and evidence of immaturity compared with those with other forms of HD, and an increased odds of MACE.</p>","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 3","pages":"56-64"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2017.1397699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35577141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Early left ventricular ejection fraction as a predictor of survival after cardiac arrest. 早期左心室射血分数作为心脏骤停后生存的预测因子。
Pub Date : 2016-06-01 Epub Date: 2017-03-22 DOI: 10.1080/17482941.2017.1293831
Barry Burstein, Dev Jayaraman, Regina Husa

Background: Cardiopulmonary resuscitation and early defibrillation have been shown to improve outcomes of cardiac arrest. The significance of the post-arrest echocardiogram, specifically the left ventricular ejection fraction (LVEF) is unknown.

Methods: We performed a retrospective cohort study of patients who suffered from cardiac arrest between 1 January 2009 and 31 December 2013. We included all patients who achieved return of spontaneous circulation (ROSC), and were admitted to the intensive care unit (ICU) or coronary care unit (CCU) of a tertiary care academic center. Patients who underwent echocardiography within 24 h of cardiac arrest were included for analysis. The primary outcome was survival.

Results: We identified 151 patients who achieved ROSC of which 97 underwent post-arrest echocardiogram within 24 h. 70.8% were males and the mean age was 67.8 years (SD: 15.9). The mean LVEF at 24 h was 35.7 (SD: 17.8). LVEF > 40% was not a predictor of survival at 30 days or hospital discharge. The only significant predictors on multivariate analyses were age, presence of shockable rhythm and time to ROSC.

Conclusion: Although echocardiograms are frequently ordered, LVEF greater than 40% in patients who are resuscitated after a cardiac arrest is not a predictor of survival.

背景:心肺复苏和早期除颤已被证明可以改善心脏骤停的结果。停搏后超声心动图的意义,特别是左心室射血分数(LVEF)是未知的。方法:我们对2009年1月1日至2013年12月31日期间发生心脏骤停的患者进行了回顾性队列研究。我们纳入了所有达到自然循环恢复(ROSC),并被三级医疗学术中心的重症监护病房(ICU)或冠状动脉监护病房(CCU)收治的患者。在心脏骤停24小时内接受超声心动图检查的患者纳入分析。主要结局是生存。结果:151例患者达到ROSC,其中97例在24 h内进行了骤停后超声心动图检查,70.8%为男性,平均年龄67.8岁(SD: 15.9)。24 h平均LVEF为35.7 (SD: 17.8)。LVEF > 40%不是30天生存率或出院的预测指标。多变量分析中唯一有意义的预测因子是年龄、休克节律的存在和到ROSC的时间。结论:尽管经常要求超声心动图,但心脏骤停后复苏的患者LVEF大于40%并不是生存的预测指标。
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引用次数: 9
Cannon A-waves due to pacemaker syndrome. 心脏起搏器综合征引起的a波。
Pub Date : 2016-06-01 Epub Date: 2017-03-20 DOI: 10.1080/17482941.2017.1293832
Jackson J Liang, John W Hirshfeld
A 67-year-old woman underwent orthotopic heart transplantation for end-stage familial cardiomyopathy. Epicardial pacing wires were placed during the transplant surgery and remained in situ. Sixteen days after transplant, she was referred for right heart catheterization and surveillance endomyocardial biopsy. Throughout the procedure, her epicardial ventricular pacing wire asynchronously paced her ventricle at 80 beats per minute. Physical examination prior to and immediately following the biopsy procedure demonstrated cannon A-waves of her right jugular venous impulse (Video 1). Right atrial hemodynamic pressure tracings demonstrated a mean right atrial pressure of 5 mmHg with A-waves to over 20 mmHg (Figure 1A), which differed from right atrial tracings measured during her previous right heart catheterization one week prior in the presence of atrioventricular synchrony (mean right atrial pressure 3 mmHg with A-waves to 5 mmHg) (Figure 1B). Following the uncomplicated procedure, epicardial ventricular pacing was discontinued and the cannon A-waves resolved completely (Video 2). She subsequently underwent implantation of dual chamber pacemaker for sinus dysfunction. Cannon A-waves are giant jugular venous pulsations classically thought to occur due to right atrial contraction against a closed tricuspid valve. Most frequently seen in conditions with atrioventricular dissociation (i.e. complete heart block, ventricular tachycardia, or atrioventricular nodal re-entry tachycardia), cannon A-waves may also be caused by ‘pacemaker syndrome’, due to loss of normal atrioventricular synchrony. With asynchronous ventricular pacing, retrograde ventriculoatrial conduction may cause atrial contraction against a closed tricuspid valve resulting in the formation of cannon A-waves. Treatment for cannon A-waves due to pacemaker syndrome is to restore atrioventricular synchrony, either by pacing the atria and ventricles synchronously, or as in our patient,
{"title":"Cannon A-waves due to pacemaker syndrome.","authors":"Jackson J Liang,&nbsp;John W Hirshfeld","doi":"10.1080/17482941.2017.1293832","DOIUrl":"https://doi.org/10.1080/17482941.2017.1293832","url":null,"abstract":"A 67-year-old woman underwent orthotopic heart transplantation for end-stage familial cardiomyopathy. Epicardial pacing wires were placed during the transplant surgery and remained in situ. Sixteen days after transplant, she was referred for right heart catheterization and surveillance endomyocardial biopsy. Throughout the procedure, her epicardial ventricular pacing wire asynchronously paced her ventricle at 80 beats per minute. Physical examination prior to and immediately following the biopsy procedure demonstrated cannon A-waves of her right jugular venous impulse (Video 1). Right atrial hemodynamic pressure tracings demonstrated a mean right atrial pressure of 5 mmHg with A-waves to over 20 mmHg (Figure 1A), which differed from right atrial tracings measured during her previous right heart catheterization one week prior in the presence of atrioventricular synchrony (mean right atrial pressure 3 mmHg with A-waves to 5 mmHg) (Figure 1B). Following the uncomplicated procedure, epicardial ventricular pacing was discontinued and the cannon A-waves resolved completely (Video 2). She subsequently underwent implantation of dual chamber pacemaker for sinus dysfunction. Cannon A-waves are giant jugular venous pulsations classically thought to occur due to right atrial contraction against a closed tricuspid valve. Most frequently seen in conditions with atrioventricular dissociation (i.e. complete heart block, ventricular tachycardia, or atrioventricular nodal re-entry tachycardia), cannon A-waves may also be caused by ‘pacemaker syndrome’, due to loss of normal atrioventricular synchrony. With asynchronous ventricular pacing, retrograde ventriculoatrial conduction may cause atrial contraction against a closed tricuspid valve resulting in the formation of cannon A-waves. Treatment for cannon A-waves due to pacemaker syndrome is to restore atrioventricular synchrony, either by pacing the atria and ventricles synchronously, or as in our patient,","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 2","pages":"40-41"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2017.1293832","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34834261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intrapulmonary artery balloon pulsation improves circulatory function after acute myocardial infarction in pigs. 肺内动脉球囊搏动改善猪急性心肌梗死后的循环功能。
Pub Date : 2016-06-01 Epub Date: 2017-03-22 DOI: 10.1080/17482941.2017.1293830
Rahma Ouardani, Nikos Magkoutis, Philippe Bonnin, Chantal Kang, Antoni W Kedra, Georgios Sideris, Michel Bonneau, Sebastian Voicu

Aim: To examine whether pulmonary artery balloon pulsation (PABP) could improve circulatory function in acute myocardial infarction (AMI) in pigs.

Methods/results: Ten downsize pigs were sedated and ventilated. AMI was induced by inserting a plug into the left anterior descending artery. A pulsation balloon was placed in the pulmonary artery in all animals. In the treatment group (TG), pulsations began when life-threatening arrhythmia or > 30% drop in mean blood pressure (MBP) or > 40% decrease in cardiac output compared to baseline occurred. Pulsation rate was 120/min, independent of the heartbeat, maintained for 10 min. The control group (CG) received no pulsation. In the TG (n = 5), mean BP after the AMI improved by 7 ± 12 mmHg after 150 min while in the CG, MBP decreased by 17 ± 25 mmHg, P < 0.05; coronary perfusion pressure improved by 8 ± 7 mmHg in the TG but decreased by 15 ± 12 in the CG (P < 0.05). In the CG, cardiac output did not change but in the TG it improved from 3.5 ± 0.9 after the AMI to 4.2 ± 1.1 l/min 150 min after AMI (P < 0.05). The TG required 1.8 ± 0.4 electric shocks for ventricular fibrillation versus 0.8 ± 0.4 in the pulsation group (P < 0.05).

Conclusion: PABP could be useful in the management of AMI due to improved mean arterial BP, coronary perfusion pressure, cardiac output and electrical stability. The mechanism of this effect remains to be determined.

目的:探讨肺动脉球囊搏动(PABP)是否能改善猪急性心肌梗死(AMI)的循环功能。方法/结果:对10头小型猪进行麻醉和通气。通过在左前降支内插入栓子诱发AMI。在所有动物的肺动脉内放置脉动球囊。在治疗组(TG)中,当发生危及生命的心律失常或平均血压(MBP)下降> 30%或心输出量与基线相比下降> 40%时开始出现脉动。脉搏率为120/min,与心跳无关,维持10 min。对照组(CG)无脉搏。TG组(n = 5) AMI后150 min平均血压升高7±12 mmHg, CG组降低17±25 mmHg, P < 0.05;TG组冠脉灌注压升高8±7 mmHg, CG组降低15±12 mmHg (P < 0.05)。在CG方面,心输出量没有变化,但在TG方面,心输出量从AMI后的3.5±0.9 l/min提高到AMI后150 min的4.2±1.1 l/min (P < 0.05)。心室颤动组TG需要1.8±0.4次电击,而搏动组则需要0.8±0.4次电击(P < 0.05)。结论:PABP可改善平均动脉血压、冠状动脉灌注压、心输出量和电稳定性,可用于AMI的治疗。这种效应的机制还有待确定。
{"title":"Intrapulmonary artery balloon pulsation improves circulatory function after acute myocardial infarction in pigs.","authors":"Rahma Ouardani,&nbsp;Nikos Magkoutis,&nbsp;Philippe Bonnin,&nbsp;Chantal Kang,&nbsp;Antoni W Kedra,&nbsp;Georgios Sideris,&nbsp;Michel Bonneau,&nbsp;Sebastian Voicu","doi":"10.1080/17482941.2017.1293830","DOIUrl":"https://doi.org/10.1080/17482941.2017.1293830","url":null,"abstract":"<p><strong>Aim: </strong>To examine whether pulmonary artery balloon pulsation (PABP) could improve circulatory function in acute myocardial infarction (AMI) in pigs.</p><p><strong>Methods/results: </strong>Ten downsize pigs were sedated and ventilated. AMI was induced by inserting a plug into the left anterior descending artery. A pulsation balloon was placed in the pulmonary artery in all animals. In the treatment group (TG), pulsations began when life-threatening arrhythmia or > 30% drop in mean blood pressure (MBP) or > 40% decrease in cardiac output compared to baseline occurred. Pulsation rate was 120/min, independent of the heartbeat, maintained for 10 min. The control group (CG) received no pulsation. In the TG (n = 5), mean BP after the AMI improved by 7 ± 12 mmHg after 150 min while in the CG, MBP decreased by 17 ± 25 mmHg, P < 0.05; coronary perfusion pressure improved by 8 ± 7 mmHg in the TG but decreased by 15 ± 12 in the CG (P < 0.05). In the CG, cardiac output did not change but in the TG it improved from 3.5 ± 0.9 after the AMI to 4.2 ± 1.1 l/min 150 min after AMI (P < 0.05). The TG required 1.8 ± 0.4 electric shocks for ventricular fibrillation versus 0.8 ± 0.4 in the pulsation group (P < 0.05).</p><p><strong>Conclusion: </strong>PABP could be useful in the management of AMI due to improved mean arterial BP, coronary perfusion pressure, cardiac output and electrical stability. The mechanism of this effect remains to be determined.</p>","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 2","pages":"42-44"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2017.1293830","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34842444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Acute cardiac care
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