Clot in Transit in a Patient with COVID-19: Transesophageal Echocardiographic Guidance of Mechanical Cardiopulmonary Resuscitation.
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ABSTRACT:
SUBMITTER: Horowitz JM
PROVIDER: S-EPMC7816862 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC7229961 | biostudies-literature
Project description:There has been no report about aortic dissection due to cardiopulmonary resuscitation (CPR). We present here a case of acute aortic dissection as a rare complication of CPR and propose the potential mechanism of injury on the basis of transesophageal echocardiographic observations. A 54-year-old man presented with cardiac arrest after choking and received 19 minutes of CPR in the emergency department. Transesophageal echocardiography (TEE) during CPR revealed a focal separation of the intimal layer at the descending thoracic aorta without evidence of aortic dissection. After restoration of spontaneous circulation, hemorrhagic cardiac tamponade developed. Follow-up TEE to investigate the cause of cardiac tamponade revealed aortic dissection of the descending thoracic aorta. Hemorrhagic cardiac tamponade was thought to be caused by myocardial hemorrhage from CPR.
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| S-EPMC8641437 | biostudies-literature
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| S-EPMC6058252 | biostudies-literature
Project description:Feedback on chest compressions and ventilations during cardiopulmonary resuscitation (CPR) is important to improve survival from out-of-hospital cardiac arrest (OHCA). The thoracic impedance signal acquired by monitor-defibrillators during treatment can be used to provide feedback on ventilations, but chest compression components prevent accurate detection of ventilations. This study introduces the first method for accurate ventilation detection using the impedance while chest compressions are concurrently delivered by a mechanical CPR device. A total of 423 OHCA patients treated with mechanical CPR were included, 761 analysis intervals were selected which in total comprised 5 884 minutes and contained 34 864 ventilations. Ground truth ventilations were determined using the expired CO 2 channel. The method uses adaptive signal processing to obtain the impedance ventilation waveform. Then, 14 features were calculated from the ventilation waveform and fed to a random forest (RF) classifier to discriminate false positive detections from actual ventilations. The RF feature importance was used to determine the best feature subset for the classifier. The method was trained and tested using stratified 10-fold cross validation (CV) partitions. The training/test process was repeated 20 times to statistically characterize the results. The best ventilation detector had a median (interdecile range, IDR) F 1-score of 96.32 (96.26-96.37). When used to provide feedback in 1-min intervals, the median (IDR) error and relative error in ventilation rate were 0.002 (-0.334-0.572) min-1 and 0.05 (-3.71-9.08)%, respectively. An accurate ventilation detector during mechanical CPR was demonstrated. The algorithm could be introduced in current equipment for feedback on ventilation rate and quality, and it could contribute to improve OHCA survival rates.
| S-EPMC7537815 | biostudies-literature
Project description:We aimed to investigate the impact of mechanical cardiopulmonary resuscitation devices over manual cardiopulmonary resuscitation on outcomes from inhospital cardiac arrests. Design:Restrospective review. Setting:Single academic medical center. Participants:Data were collected on all patients who suffered cardiac arrest from December 2015 to November 2019. Main Outcomes and Measures:Primary end point was return of spontaneous circulation. Secondary end points included survival to discharge and survival to discharge with favorable neurologic outcomes. Results:About 104 patients were included in the study: 59 patients received mechanical cardiopulmonary resuscitation and 45 patients received manual cardiopulmonary resuscitation during the enrollment period. Return of spontaneous circulation rate was 83% in the mechanical cardiopulmonary resuscitation group versus 48.8% in the manual group (p = 0.009). Survival-to-discharge rate was 32.2% in the mechanical cardiopulmonary resuscitation group versus 11.1% in those who received manual cardiopulmonary resuscitation (p = 0.02). Of the patients who survived to discharge and received mechanical cardiopulmonary resuscitation, 100% (n = 19) had a favorable neurologic outcome versus 40% (two out of five) of patients who survived and received manual cardiopulmonary resuscitation (p = 0.005). Conclusions:Our findings demonstrate a significant association of improved outcomes with mechanical cardiopulmonary resuscitation over manual cardiopulmonary resuscitation during inhospital cardiac arrests. Mechanical cardiopulmonary resuscitation may improve rates of return of spontaneous circulation, survival to discharge, and favorable neurologic outcomes.
| S-EPMC7671880 | biostudies-literature
Project description:BackgroundFluoroscopic guidance is the traditional method for the implantation of transvenous temporary cardiac pacemakers (TVTPs). This study aimed to compare the time, effectiveness, and safety of real-time three-dimensional transesophageal echocardiography (3D TEE) with those of fluoroscopy in guiding TVTP implantation.MethodsThe records of patients who underwent transcatheter aortic valve implantation (TAVI) guided by real-time 3D TEE or fluoroscopy between July 1, 2016, and June 30, 2020, were retrospectively analyzed. TVTPs were implanted by anesthesiologists via the right internal jugular vein (IJV) in the real-time 3D TEE-guided group (3D TEE group), and by interventional cardiologists via the femoral vein in the fluoroscopy-guided group (fluoro group).ResultsA total of 143 patients (3D TEE-group n=79, and fluoro group n=64) were included. No statistical differences were observed in the baseline characteristics of the two groups. TVTPs were successfully implanted in all of the patients. The needle-to-pace time was significantly shorter in 3D TEE group than in fluoro group (5.2±2.9 vs. 8.5±4.6 min, P<0.001). Further, the incidence of access complications was significantly lower in 3D TEE group than in fluoro group (3.8% vs. 12.5%, P<0.05). One patient in fluoro group who suffered cardiac perforation underwent drainage via pericardiocentesis. No patients in either group died because of TVTP placement. The total complication rates were significantly lower in 3D TEE group than in fluoro group (19.0% vs. 39.1%, P<0.05). No statistically significant differences existed between groups in terms of pacing threshold, the incidence of permanent pacemaker insertion after surgery, the length of postoperative intensive care unit (ICU) stay, or the duration of postoperative hospitalization.ConclusionsReal-time 3D TEE-guided can be used to effectively, quickly, and safely guide TVTP implantation. The procedure can be performed by properly trained anesthesiologists. Therefore, real-time 3D TEE is a suitable option for guiding perioperative TVTP implantation in patients undergoing cardiac surgery.
| S-EPMC7607070 | biostudies-literature
Project description:BackgroundExtracorporeal membrane oxygenation (ECMO) to support cardiopulmonary resuscitation (CPR), also known as extracorporeal cardiopulmonary resuscitation (ECPR), has shown encouraging results in refractory cardiac arrest (RCA) resuscitation. However, its therapeutic benefits are linked to instant and uninterrupted chest compression (CC), besides early implementation. Mechanical CC can overcome the shortcomings of conventional manual CC, including fatigue and labor consumption, and ensure adequate blood perfusion. A strategy sequentially linking mechanical CPR with ECPR may earn extra favorable outcomes.Case seriesWe present a four-case series with ages ranging from 8 to 94 years who presented with prolonged absences of return of spontaneous circulation (ROSC) after CA associated with acute fulminant myocarditis (AFM) and myocardial infarction (MI). All the cases received VA-ECMO (ROTAFLOW, Maquet) assisted ECPR, with intra-aortic balloon pump (IABP) or continuous renal replacement treatment (CRRT) appended if persistently low mean blood pressure (MAP) or ischemic kidney injury occurred. All patients have successfully weaned off ECMO and the assistant life support devices with complete neurological recovery. Three patients were discharged, except the 94-year-old patient who died of irreversible sepsis 20 days after ECMO weaning-off. These encouraging results will hopefully lead to more consideration of this lifesaving therapy model that sequentially integrates mechanical CPR with ECPR to rescue RCA related to reversible cardiac causes.ConclusionsThis successful case series should lead to more consideration of an integrated lifesaving strategy sequentially linking mechanical cardiopulmonary resuscitation with ECPR, as an extra favorable prognosis of refractory cardiac arrest related to this approach can be achieved.
| S-EPMC9145112 | biostudies-literature
Project description:The prohibitive risk of isolated tricuspid valve (TV) surgery encouraged rapid development of a transcatheter solution for tricuspid regurgitation (TR). The favorable results of these devices informed recent guidelines to recommend considering transcatheter treatment of symptomatic secondary severe TR in inoperable patients. Transcatheter TV repair systems usually reduce TR through leaflet approximation and direct annuloplasty. Orthotopic transcatheter TV replacement (TTVR) devices generally rely on radial force and tricuspid leaflet engagement for implantation and stability. The LuX-Valve is a novel radial force-independent orthotopic TTVR device that is operated through the trans-atrial approach. Its radial force-independency is achieved through an interventricular septal anchor tab (septal insertion) and two leaflet graspers (leaflet engagement). Such a unique design makes the intraprocedural imaging different from that of other currently available TTVR systems. The latest generation of this device, the LuX-Valve Plus, comes with a newly designed delivery system through the transjugular approach, which makes the intraprocedural monitoring and adjustment of the device even more complex for successful implantation. However, its unique imaging needs for intra-procedural guidance and post-operative evaluation have not been described before. Therefore, we aimed to elaborate the key steps of transesophageal echocardiography (TEE) to guide this novel procedure. Herein, the primary 2-dimensional (2D) and 3-dimensional (3D) echocardiographic work planes are proposed and the critical steps are emphasized for better communication between imagers and interventionists. The suitability of 2D and 3D echocardiography to guide this procedure is also discussed to increase the flexibility of choice during the implantation.
| S-EPMC10784097 | biostudies-literature
Project description:Aortic pseudoaneurysm after cardiac surgery is a rare entity, but it is potentially fatal due to its clinical course along with higher morbidity and mortality rates. Instead of open surgical repair, percutaneous procedures have been introduced as other options for managing an aortic pseudoaneurysm. In this case report, we describe transesophageal echocardiography guidance for successful percutaneous closure of an aortic pseudoaneurysm located in the left ventricular outflow tract by using a type II Amplatzer vascular plug in a patient in whom open surgical repair was not recommended.
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