Anastasios Koutsovasilis

Airway pressure and outcome of out-of-hospital cardiac arrest: A prospective observational study ☆

AIM To assess the usefulness of airway pressure as predictor of return of spontaneous circulation (ROSC), as well as to investigate the optimized ventilation compression strategy during cardiopulmonary resuscitation (CPR). METHODS In this prospective observational study, 300 out-of-hospital cardiac arrest victims were intubated and resuscitated with the use of a ventilator. Mean airway pressure (mPaw) was measured at pre-defined phases of CPR. RESULTS A significant difference in mPaw was observed between survivors and non-survivors after the onset of the third minute of CPR. An mPaw value of 42.5mbar during CPR had specificity and sensitivity of 0.788 and 0.804, respectively, for ROSC (AUC=0.668, p=0.047). During CPR, we found statistically significant differences in mPaw at phases zero (F=4.526, p=0.002), two (F=4.506, p=0.002), four (F=8.187, p<0.0001), five (F=2.871, p=0.024), and six (F=5.364, p<0.0001). CONCLUSION Mean airway pressure was higher in survivors. A value of 42.5mbar was associated with ROSC.

Outcomes of cardiopulmonary resuscitation efforts in a Greek tertiary hospital.

Abstract Introduction: In-hospital cardiac arrest is a leading cause of death and despite recent advances in cardiopulmonary resuscitation, the survival to hospital discharge is poor. The aim of our study was to evaluate the success of resuscitation efforts in a tertiary hospital. Patients and Methods: We retrospectively collected and analysed data on all patients in whom cardiopulmonary resuscitation was attempted after in-hospital cardiac arrest in one-year period. Results: 96 cardiac arrest victims were studied. Sustained return of spontaneous circulation was achieved in 15 (15.6%) patients, while all of them survived for 24 h. Training in cardiopulmonary resuscitation, initiation of resuscitation efforts in less than 5 min, and intubation time < 1 min after team arrival were predictive factors associated with restoration of spontaneous circulation. Non-certified residents resuscitated 87 (90.6%) patients with 6 (6.8%) of them achieving return of spontaneous circulation and surviving for 24 h. On the contrary, certified ward residents resuscitated nine (9.3%) patients with 100% immediate and 24-h survival. Conclusion: In our hospital, certified providers had remarkably higher successful resuscitation rates for in-hospital cardiac arrest than non-certified providers. This finding suggests that training in cardiopulmonary resuscitation, continuing medical education, and implementation of the existing legislation will result in increased survival.

Intralipid™ administration attenuates the hypotensive effects of acute intravenous amiodarone overdose in a swine model.

PURPOSE To investigate whether a lipid emulsion could counteract the hypotensive effects of amiodarone overdose after an acute intravenous administration and improve 4 h survival in an established model of swine cardiovascular research. METHODS Twenty pigs were intubated and instrumented to measure aortic pressures and central venous pressures (CVP). After allowing the animals to stabilize for 60 minutes, amiodarone overdose (1 mg/kg/min) was initiated for a maximum of 20 minutes. Afterwards, the animals were randomized into 2 groups. Group A (n = 10) received 0.9% Normal Saline (NS) and Group B (n = 10) received 20% Intralipid® (ILE). A bolus dose of 2 ml/kg in over 2 min time was initially administered in both groups followed by a 45 min infusion (0.2 ml/kg/min) of either NS or ILE. RESULTS All animals survived the overdose and all animals survived the monitoring period of 4 hours. Systolic aortic pressure (SpthAorta) (6.90 vs 14.10 mmHg, P = .006) and mean arterial pressure (MAP) (6.10 vs 14.90 mmHg, P = .001) were higher in the ILE group 2 min after the bolus ILE infusion. This difference was maintained for 15 min after ILE infusion for both SpthAorta (7.85 vs 13.15 mmHg, P = .044) and MAP (7.85 vs 13.15 mmHg, P = .042). Animals that received ILE had higher CVP (11.6 vs 15.7 mmHg, P = .046), an effect which was attenuated 2 and 4 hours post administration. Animals receiving ILE were more acidotic (7.21 vs 7.38, P = .048) in the monitoring period compared to animals receiving NS. CONCLUSIONS Intralipid attenuated the hypotensive effects of amiodarone toxicity for a period of 15 minutes compared to animals receiving NS.

Addition of glucagon to adrenaline improves hemodynamics in a porcine model of prolonged ventricular fibrillation.

OBJECTIVE Cardiac arrest is a daunting medical emergency. The aim of the present study was to assess whether the combination of adrenaline and glucagon would improve initial resuscitation success, 48-hour survival, and neurologic outcome compared with adrenaline alone in a porcine model of ventricular fibrillation. METHODS Ventricular fibrillation was induced in 20 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 minutes. The animals were randomized to receive adrenaline alone (n = 10, group C) and adrenaline plus glucagon (n = 10, group G). All animals were resuscitated according to the 2010 European Resuscitation Council guidelines. Hemodynamic variables were measured before arrest, during arrest and resuscitation, and during the first 60 minutes after return of spontaneous circulation. Survival and a neurologic alertness score were measured at 48 hours after return of spontaneous circulation. RESULTS Return of spontaneous circulation was achieved in 8 animals (80%) from group C and 10 animals (100%) from group G (P = .198). A significant gradual increase in coronary perfusion pressure and diastolic aortic pressure over time, which started 1 minute after the onset of cardiopulmonary resuscitation, was observed. Three animals (30%) from group C and 9 animals (90%) from group G survived after 48 hours (P = .006), whereas neurologic examination was significantly better in the animals of group G (P < .001). CONCLUSIONS In this porcine model of prolonged ventricular fibrillation, the addition of glucagon to adrenaline improves hemodynamics during resuscitation and early postresuscitation period and may increase survival.

Characteristics and survival to discharge of patients with STEMI between a PPCI-capable hospital and a non-PPCI hospital: a prospective observational study.

Abstract Introduction: Primary percutaneous coronary intervention (PPCI) is a key therapeutic method in the treatment of ST-elevation myocardial infarction (STEMI). We studied the characteristics and survival to discharge in STEMI patients who presented in a PPCI-capable hospital and a non-PPCI hospital. Patients and Methods: This prospective observational study included 240 consecutive patients. One basic questionnaire was distributed along with an explanatory letter to the participants, who were followed until discharge from the hospital or death. Results: Of the 240 patients, 234 (97.5%) survived to hospital discharge. Only 6 (5%) patients who were initially presented to a non-PPCI hospital died after inter-facility transfer. Also, 36 (92.3%) of the 39 patients with an intervening time of over 90 min were admitted initially in a non-PPCI hospital. Although there was a statistically significant correlation between the type of the hospital and the delay from the onset of symptoms to PPCI (P = 0.001), such correlation was not found between the delay PPCI and the outcome of the patients (P > 0.05). Conclusion: Patients with STEMI may be transferred to a non-PPCI hospital due to the lack of prehospital triage. However, prompt inter-facility transfer results in good outcome.

Influence of electromagnetic interference on AED function in metro stations

metro stations Athanasios Chalkias ⁎, Anastasios Koutsovasilis , Violetta Raffay , Claudio Sandroni , Jerzy Jaskula , Nicoletta Iacovidou , Theodoros Xanthos a,1 a National and Kapodistrian University of Athens, Medical School, MSc “Cardiopulmonary Resuscitation”, Athens, Greece b Emergency Medicine, Municipal Institute for Emergency Medicine Novi Sad, AP Vojvodina, Novi Sad, Serbia c Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy d Polish Resuscitation Council, Krakow, Poland