Trans-nasal cooling during CPR: a single-center experience

IntroductionTrans-nasal cooling started during cardiopulmonary resuscitation (CPR) has shown to improve the return to spontaneous circulation (ROSC) and survival rate in an experimental prolonged cardiac arrest model. A multicenter randomized trial (PRINCE) has also suggested an improved neurological outcome in patients receiving trans-nasal cooling during CPR in the prehospital setting when compared with those treated by conventional hypothermia on hospital arrival, provided a delay between collapse and CPR of less than 10 minutes. MethodsPatients with witnessed cardiac arrest and a downtime less than 20 minutes were randomized to prehospital intra-arrest cooling versus standard ACLS care. Trans-nasal cooling (RhinoChill, BeneChill Inc. CA, USA) was initiated using a mixture of volatile coolant fluid with oxygen delivered into the nasopharynx for rapid evaporative heat transfer. Cooling was continued during CPR and, for patients who achieved ROSC, until initiation of systemic cooling at hospital. Resuscitation was continued for at least 30 minutes. All patients were then cooled at the hospital. ResultsTwenty-four patients were included, but one in the treatment group was excluded from the per-protocol analysis because of DNR orders. Patients randomized to treatment group (n = 9) or standard care (n = 14) had similar demographics, initial rhythm, time from collapse to CPR and ALS arrival. Median time from collapse to cooling initiation was 19 minutes. In total, 6/9 (66%) treated and 6/14 (42%) control patients achieved ROSC. Three patients (33%) in the treatment group survived to hospital discharge with CPC 1 to 2, while only one (7%) of the control group patients had good neurological outcome. No serious adverse events occurred in treated patients. ConclusionsTrans-nasal cooling seems to be safe and feasible in a prehospital setting. These single-center data confirm that trans-nasal cooling may improve the ROSC rate as well as good neurological outcome if started in patients with a short delay between collapse and CPR.info:eu-repo/semantics/publishe

Real-World Inter-Observer Variability of the Sequential Organ Failure Assessment (SOFA) Score in Intensive Care Medicine: the Time Has come for an Update: Authors’ Reply

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Should red cell transfusion be individualized? Yes

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Levels of procoagulant microvesicles are elevated after traumatic injury and platelet microvesicles are negatively correlated with mortality

Background: Microvesicles (MV) have been implicated in the development of thrombotic disease, such as acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF). Trauma patients are at increased risk of late thrombotic events, particularly those who receive a major transfusion. The aims of this study were: (a) to determine whether there were increased numbers of pro-coagulant MV following injury; (b) to determine their cellular origin; and (c) to explore the effects of MV with clinical outcomes; in particular red cell transfusion requirements and death. Methods: Trauma patients were recruited at a Level 1 trauma centre. The presence of MV procoagulant phospholipid (PPL) was assessed using 2 activity assays (PPL and thrombin generation). Enumeration and MV cellular origin was assessed using 2 colour flow cytometry. Results: Fifty consecutive patients were recruited; median age 38 (IQR: 24–55), median ISS 18 (IQR: 9–27). Circulating procoagulant MV, rich in phospholipid, were significantly elevated following traumatic injury relative to controls and remained elevated at 72 h post-injury. Red cell/AnnV+ and platelet/AnnV+ MV numbers were 6-fold and 2-fold higher than controls, respectively. Patients who died (n=9, 18%) had significantly fewer CD41/AnnV+ MV and lower endogenous thrombin potential relative to patients who survived. Conclusions: MV are elevated following traumatic injury and may be implicated in the increased risk of trauma patients to pro-thrombotic states such as MOF and ARDS. Lower levels of procoagulant MV are associated with mortality and further investigation of this association is warranted

ASSESSMENT OF CHLORIDE LEVELS ON RENAL FUNCTION AFTER CARDIAC ARREST

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