Thrombotic Microangiopathy Score as a New Predictor of Neurologic Outcomes in Patients after Out-of-Hospital Cardiac Arrest

PurposeGiven the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be automatically and accurately measured. This study aimed to investigate whether serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA).Materials and MethodsWe retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed TMA scores at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurological outcome at discharge and 30-day mortality.ResultsIncreased TMA scores at all measured time points were independent predictors of poor neurological outcomes and 30-day mortality, with TMA score at time-12 showing the strongest correlation [odds ratio (OR), 3.008; 95% confidence interval (CI), 1.707–5.300; p<0.001 and hazard ratio (HR), 1.517; 95% CI, 1.196–1.925; p<0.001]. Specifically, a TMA score ≥2 at time-12 was closely associated with an increased predictability of poor neurological outcomes (OR, 6.302; 95% CI, 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI, 1.675–4.211; p<0.001).ConclusionIncreased TMA scores predicted neurological outcomes and 30-day mortality in patients undergoing TTM after OHCA. In addition to the benefit of being serially measured using an automated hematology analyzer, TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with return of spontaneous circulation after OHCA.     

围手术期心跳骤停的危险因素分析

目的探讨围手术期心跳骤停的危险因素，为有效预防围手术期心跳骤停提供科学依据。方法采用病例对照研究，选取1996-2006年菏泽市立医院16例围手术期心脏骤停病人为病例组，同时选择同期、性别、年龄匹配的60例未发生心跳骤停的病人作为对照组，对相关危险因素进行单因素和多因素Logistic回归分析。结果术前心脏功能差、术中缺氧、失血性休克、电解质紊乱、迷走神经反射是围手术期病人发生心跳骤停的危险因素，OR值分别为2．625、1．055、1．901、6．337和6．507。结论在围手术期心跳骤停的预防工作中，改善择期手术病人的心脏功能；术中注意给氧，输血，维持电解质平衡，避免牵拉迷走神经是有效的预防措施。     

Epidemiology and Outcome of Out-of-Hospital Cardiac Arrests during the COVID-19 Pandemic in South Korea: A Systematic Review and Meta-Analyses

PurposeTo evaluate the effect of coronavirus disease 2019 (COVID-19) on out-of-hospital cardiac arrest (OHCA) outcomes in South Korea, we conducted systematic review and meta-analysis.Materials and MethodsMEDLINE, Embase, KoreaMed, and Korean Information Service System databases were searched up to June 2022. We included observational studies and letters on OHCA during the COVID-19 pandemic and compared them to those before the pandemic. Epidemiologic characteristics, including at-home OHCA, bystander cardiopulmonary resuscitation, unwitnessed arrest, use of an automated external defibrillator (AED), shockable cardiac rhythm, and airway management, were evaluated. Survival and favorable neurological outcomes were extracted. We conducted a meta-analysis of each characteristic and outcome.ResultsSix studies including 4628 OHCA patients were included in this study. The incidence of at-home OHCA significantly increased and the AED use decreased during the COVID-19 pandemic compared to before the pandemic [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.08–1.55; I²=0% and OR, 0.74; 95% CI, 0.57–0.97; I²=0%, respectively]. Return of spontaneous circulation after OHCA, survival, and favorable neurological outcomes during and before the pandemic did not differ significantly (OR, 0.90; 95% CI, 0.71–1.13; I²=37%; OR, 0.74; 95% CI, 0.43–1.26; I²=72%; OR, 0.77; 95% CI, 0.43–1.37; I²=70%, respectively).ConclusionDuring the COVID-19 pandemic in South Korea, the incidence of at-home OHCA increased and AED use decreased among OHCA patients. However, survival and favorable neurological outcomes did not significantly differ from before the pandemic. This insignificant effect of the pandemic on OHCA in South Korea could be attributed to the slow increase in patient count in the early days of the pandemic.OSF Registry (DOI: 10.17605/OSF.IO/UGE9D).     

Specific Activity Types at the Time of Event and Outcomes of Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group.     

Interactions between Sleep Apnea and Coronary Artery Disease on the Incidence of Sudden Cardiac Arrest: A Multi-Center Case-Control Study

PurposeSleep apnea (SA) is a risk factor for coronary artery disease (CAD), and SA and CAD increase the incidence of sudden cardiac arrest (SCA). This study aimed to investigate the effect of SA on the incidence of SCA and explore the effect of varying degrees of SA with or without CAD on the incidence of SCA.Materials and MethodsThis prospective multi-center, case-control study was performed using the phase II Cardiac Arrest Pursuit Trial with Unique Registry and Epidemiologic Surveillance (CAPTURES-II) database for SCA cases and community-based controls in Korea. The matching ratio of cases to controls was 1:1, and they were randomly matched within demographics, including age, sex, and residence. The primary variable was a history of SA, and the second variable was a history of CAD. We conducted a conditional logistic regression analysis to estimate the effect of SA and CAD on the SCA risk, and an interaction analysis between SA and CAD.ResultsSA was associated with an increased risk of SCA [adjusted odds ratio (AOR) (95% confidence interval, CI): 1.54 (1.16–2.03)], and CAD was associated with an increased risk of SCA [AOR (95% CI): 3.94 (2.50–6.18)]. SA was a risk factor for SCA in patients without CAD [AOR (95% CI): 1.62 (1.21–2.17)], but not in patients with CAD [AOR (95% CI): 0.56 (0.20–1.53)].ConclusionIn the general population, SA is risk factor for SCA only in patients without CAD. Early medical intervention for SA, especially in populations without pre-existing CAD, may reduce the SCA risk. ClinicalTrials.gov ({"type":"clinical-trial","attrs":{"text":"NCT03700203","term_id":"NCT03700203"}}NCT03700203)     

基于小波变换和Adaboost算法的心脏骤停预测模型研究

为了预测心脏骤停,应用小波变换和Adaboost算法建立心脏骤停预测模型。首先用小波变换方法对正常窦性心律心电数据和有心脏骤停症状患者的心电数据进行分析、提取特征值,再用Adaboost算法对两种数据进行分类来预测心脏骤停的发生。实验验证,本模型分类预测效果较好,在心脏骤停发生前5min,其预测精度高达97.56%,为心脏骤停的预测提供了一种有参考价值的方法。     

Survival and Neurologic Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Were Transferred after Return of Spontaneous Circulation for Integrated Post-Cardiac Arrest Syndrome Care: The Another Feasibility of the Cardiac Arrest Center

It has been proven that safety and efficiency of out-of-hospital cardiac arrest (OHCA) patients is transported to specialized hospitals that have the capability of performing therapeutic hypothermia (TH). However, the outcome of the patients who have been transferred after return of spontaneous circulation (ROSC) has not been well evaluated. We conducted a retrospective observational study between January 2010 to March 2012. There were primary outcomes as good neurofunctional status at 1 month and the secondary outcomes as the survivals at 1 month between Samsung Medical Center (SMC) group and transferred group. A total of 91 patients were enrolled this study. There was no statistical difference between good neurologic outcomes between both groups (38% transferred group vs. 40.6% SMC group, P=0.908). There was no statistical difference in 1 month survival between the 2 groups (66% transferred group vs. 75.6% SMC group, P=0.318). In the univariate and multivariate models, the ROSC to induction time and the induction time had no association with good neurologic outcomes. The good neurologic outcome and survival at 1 month had no significant differences between the 2 groups. This finding suggests the possibility of integrated post-cardiac arrest care for OHCA patients who are transferred from other hospitals after ROSC in the cardiac arrest center.

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Epidemiology and Outcomes in Out-of-hospital Cardiac Arrest: A Report from the NEDIS-Based Cardiac Arrest Registry in Korea

Sudden cardiac death (SCD) is a significant issue affecting national health policies. The National Emergency Department Information System for Cardiac Arrest (NEDIS-CA) consortium managed a prospective registry of out-of-hospital cardiac arrest (OHCA) at the emergency department (ED) level. We analyzed the NEDIS-CA data from 29 participating hospitals from January 2008 to July 2009. The primary outcomes were incidence of OHCA and final survival outcomes at discharge. Factors influencing survival outcomes were assessed as secondary outcomes. The implementation of advanced emergency management (drugs, endotracheal intubation) and post-cardiac arrest care (therapeutic hypothermia, coronary intervention) was also investigated. A total of 4,156 resuscitation-attempted OHCAs were included, of which 401 (9.6%) patients survived to discharge and 79 (1.9%) were discharged with good neurologic outcomes. During the study period, there were 1,662,470 ED visits in participant hospitals; therefore, the estimated number of resuscitation-attempted CAs was 1 per 400 ED visits (0.25%). Factors improving survival outcomes included younger age, witnessed collapse, onset in a public place, a shockable rhythm in the pre-hospital setting, and applied advanced resuscitation care. We found that active advanced multidisciplinary resuscitation efforts influenced improvement in the survival rate. Resuscitation by public witnesses improved the short-term outcomes (return of spontaneous circulation, survival admission) but did not increase the survival to discharge rate. Strategies are required to reinforce the chain of survival and high-quality cardiopulmonary resuscitation in Korea.

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Two cases of asystolic cardiac arrests managed with therapeutic hypothermia

Poor neurological outcome is a common sequel of prolonged cardiac arrest. Although Therapeutic Hypothermia (TH) for neuroprotection has been a subject for research for over Half a century, its use has been limited because of many controversies and lack of clear guidelines. However for over two decades there has been a revival of interest in mild therapeutic hypothermia (32-34°C) for neuroprotection. However its use after primary asystolic cardiac arrest has been questioned.Herein presenting two cases of prolonged asystolic arrest (39 minutes and 25 minutes); where therapeutic hypothermia was successfully used in following prolonged cardio pulmonary resuscitation. On patients who were in deep coma after resuscitation, TH was applied for 24 hours as per institutional protocol with full neurological recovery in both the cases. Therapeutic hypothermia might have a potential role in even in non-shockable arrests and should be considered in every successful cardiopulmonary resuscitation with poor neurological status.     

优化治疗对我院急诊心脏骤停后综合征患者预后的影响

目的 比较优化治疗和常规ICU治疗对急诊心脏骤停后综合征患者预后及生活质量的影响。方法 选取2012年8月~2016年4月空军军医大学第一附属医院急诊科尚未开展心肺复苏后优化治疗,进行常规ICU治疗的院内心肺复苏术后的患者38例设为对照组;2016年4月~2018年7月开展优化治疗的院内心肺复苏术后的患者36例设为实验组。比较两组患者复苏后心脏及循环功能的恢复程度,神经功能恢复程度,同时对比两组患者肺部感染、心律失常等并发症的发生率。结果 实验组CI、CO较对照组升高,差异有统计学意义（P＜0.05）,PPV较对照组下降,统计学意义显著（P＜0.01）;神经功能恢复程度优于对照组（P＜0.01）,实验组患者肺部感染、肾功能衰竭、电解质紊乱、癫痫及心律失常的疾病总发生率低于对照组（P＜0.05）。结论 对心脏骤停后综合征的患者进行优化治疗,可改善患者神经功能、心脏功能及自主循环的恢复,减少并发症的发生率,对提高生存质量意义重大。     

Long-Term Preoperative Atorvastatin or Rosuvastatin Use in Adult Patients before CABG Does Not Increase Incidence of Postoperative Acute Kidney Injury: A Propensity Score-Matched Analysis

Background: Acute kidney injury (AKI) is among the expected complications of cardiac surgery. Statins with pleiotropic anti-inflammatory and antioxidant effects may be effective in the prevention of AKI. However, the results of studies on the efficacy and safety of statins are varied and require further study. Methods: We conducted a retrospective cohort study to evaluate long-term preoperative intake of atorvastatin and rosuvastatin on the incidence of AKI, based on the “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria in the early postoperative period after coronary artery bypass graft surgery (CABG). We performed propensity score matching to compare the findings in our study groups. The incidence of AKI was assessed on day 2 and day 4 after the surgery. Results: The analysis included 958 patients after CABG. After 1:1 individual matching, based on propensity score, the incidence of AKI was comparable both on day 2 after the surgery (7.4%) between the atorvastatin group and rosuvastatin group (6.5%) (OR: 1.182; 95%Cl 0.411–3.397; p = 0.794), and on postoperative day 4 between the atorvastatin group (3.7%) and the rosuvastatin group (4.6%) (OR: 0.723, 95%Cl 0.187–2.792; p = 0.739). Additionally, there were no statistically significant differences in terms of incidence of AKI after 1:1 individual matching, based on propensity score, between the rosuvastatin group and the control group both on postoperative day 2 (OR: 0.692; 95%Cl 0.252–1.899; p = 0.611) and day 4 (OR: 1.245; 95%Cl 0.525–2.953; p = 0.619); as well as between the atorvastatin group and the control group both on postoperative day 2 (OR: 0.549; 95%Cl 0.208–1.453; p = 0.240) and day 4 (OR: 0.580; 95%Cl 0.135–2.501; p = 0.497). Conclusion: Long-term statin use before CABG did not increase the incidence of postoperative AKI. Further, we revealed no difference in the incidence of post-CABG AKI between the atorvastatin and rosuvastatin groups.     

16例心脏骤停原因及心肺复苏结果分析

目的分析引起心脏骤停（CA）的原因和进行心肺复苏（CPR）结果。方法总结我院近2年抢救的16例CA临床资料,对所致CA原因及进行CPR主要抢救措施和结果进行回顾性分析。结果复苏成功7例（43．75％）,失败9例（56．25％）,低血钾、部分医疗操作可诱发CA,室颤、窦性停搏、迷走神经张力增高等是CA的直接原因,及时并积极有效地进行心肺复苏是抢救成功的关键。结论及时发现和处理引起CA的诱因是避免CA发生的关键因素,机械通气、脑保护,对提高CPR成功至关重要。     

Effect of Smoking on Outcomes of Allogeneic Transplantation: A Single-Center Analysis

Pulmonary complications are fatal adverse events after allogeneic hematopoietic cell transplantation (allo-HCT). On the other hand, smoking is a well-known risk factor for various pulmonary diseases and also increases the incidence of pulmonary complications and overall mortality in allo-HCT recipients. In this study, we retrospectively assessed the impact of smoking intensity on survival outcomes. This study included consecutive allo-HCT recipients at our center between June 2007 and May 2019 whose smoking profiles were available (n = 408); they were divided into high (pack-years >10, n = 171) and low (pack-years ≤10, n = 231) pack-years groups. In univariate analyses, nonrelapse mortality (NRM) and overall survival (OS) were significantly inferior in the high pack-years group (1-year NRM 26.6% versus 13.9%, P < .001; 1-year OS 58.4% versus 70.1%, P = .0067). However, this association was not observed in multivariate analyses. In subgroup analyses according to sex, the survival outcomes in the high pack-years group were significantly inferior in males (NRM hazard ratio [HR], 2.24 [95% confidence interval (CI), 1.23 to 4.07], P = .0082; OS HR, 1.54 [95% CI, 1.04 to 2.28], P = .031), but not in females (NRM HR, 0.587 [95% CI, 0.241 to 1.43], P = .24; OS HR, 0.689 [95% CI, 0.400 to 1.19], P = .18). In summary, high pack-years were associated with inferior survival of allo-HCT recipients, especially in males.     

Effect of Lipoxin A4 on Myocardial Ischemia Reperfusion Injury Following Cardiac Arrest in a Rabbit Model

In the present study, we investigated the effect of lipoxin A4 on myocardial ischemia–reperfusion injury (IRI) following cardiac arrest (CA) in a rabbit model. Lipoxin A4 is a metabolite of arachidonic acid in the eicosanoid, it is called “brake signal” for its anti-inflammatory activity. Some inflammatory factors (IL-1β, IL-6, TNF-α, and IL-10), NF-κB p65, infarct ratios, apoptotic index, cardiac troponin I (cTnI), hemodynamic and myocardial structures were measured or observed in different groups. Lipoxin A4 inhibits the expression of IL-1β, IL-6, and TNF-α, the values of the infarct ratios, apoptotic index, the level of serum cTnI and NF-κB p65. Meanwhile, it improves the expression of IL-10, hemodynamic, myocardial structure, and function. These indicate that lipoxin A4 mitigates postresuscitation myocardial IRI in which anti-inflammation and suppression of NF-κB activation may play an important role.     

新活素治疗低心排血量综合征的效果观察

目的 观察新活素（重组人脑利钠肽）治疗低心排血量（CO）综合征患者的临床疗效。方法 收集2018年1月~2019年1月在我院心血管内科、CCU和河南省人民医院CCU住院的低心排血量综合征患者189例,采用随机数字表法分为常规治疗组和新活素治疗组。常规治疗组患者接受常规治疗,新活素治疗组患者在常规治疗组基础上加用新活素治疗,比较两组治疗前后收缩压、舒张压、心率、血肌酐水平、心脏指数、NT-pro-BNP及尿量。结果 治疗后,两组患者心率、收缩压、舒张压、血肌酐、心脏指数等指标均较治疗前改善,差异有统计学意义（P＜0.05）;新活素治疗组患者心脏指数、NT-proBNP、尿量分别为（2.81±0.46）L/（min·m2）、（452.53±62.13）pg/ml、（1206.56±64.52）ml/24h,均优于常规治疗组的（2.42±0.69）L/（min·m2）、（525.23±66.25）pg/ml、（836.52±59.32）ml/24h,差异有统计学意义（P＜0.05）;两组收缩压、舒张压、血肌酐比较,差异无统计学意义（P＞0.05）。结论 在常规治疗低心排血量综合征基础上,给予新活素治疗,可以提高低心排血量综合征的疗效,改善患者生活质量,减少住院时间。     

The Effect of Single Embryo Transfer on Perinatal Outcomes in Japan

Objective: In 2007 and 2008, the Japan Society for Reproductive Medicine and the Japan Society of Obstetrics and Gynecology issued a recommendation for single embryo transfer (SET). Thereafter, SET was implemented in 73% of in vitro fertilization (IVF) cases in Japan. The purpose of this study was to evaluate the effects of compliance with the SET recommendation on perinatal outcomes.Methods: An electronic audit of the perinatal database of the Japanese Society of Obstetrics and Gynecology was conducted from 2001 through 2010. The database comprised data of 610,726 women. Totally, 20,923 women conceived through IVF. To compare perinatal outcomes, these women were categorized into two study groups depending on whether they conceived before (2004-2005, n = 3,865) or after (2009-2010, n = 6,842) the SET recommendation statement was issued.Results: The proportion of women who conceived through IVF increased from 1.3% in 2001 to 4.8% in 2010. Compliance with the SET recommendation led to a decrease in the incidence of twin pregnancies (33.9% versus 13%, p < 0.01), incidence of preterm delivery (odds ratio [OR]: 0.54, 95% confidence interval [CI]: 0.50-0.59), low birth weight (OR: 0.42, 95% CI: 0.39-0.45), and neonatal intensive care unit admission (OR 0.70, 95% CI 0.65-0.76), but an increase in the incidence of monochorionic twins (1.6% versus 2.5%, p < 0.01).Conclusion: Compliance with the SET recommendation improved perinatal outcomes by reducing the incidence of twin pregnancies.