Difference in end-tidal CO(2 )between asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest in the prehospital setting

INTRODUCTION: There has been increased interest in the use of capnometry in recent years. During cardiopulmonary resuscitation (CPR), the partial pressure of end-tidal carbon dioxide (PetCO(2)) correlates with cardiac output and, consequently, it has a prognostic value in CPR. This study was undertaken to compare the initial PetCO(2 )and the PetCO(2 )after 1 min during CPR in asphyxial cardiac arrest versus primary cardiac arrest. METHODS: The prospective observational study included two groups of patients: cardiac arrest due to asphyxia with initial rhythm asystole or pulseless electrical activity, and cardiac arrest due to acute myocardial infarction or malignant arrhythmias with initial rhythm ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The PetCO(2 )was measured for both groups immediately after intubation and then repeatedly every minute, both for patients with and without return of spontaneous circulation (ROSC). RESULTS: We analyzed 44 patients with asphyxial cardiac arrest and 141 patients with primary cardiac arrest. The first group showed no significant difference in the initial value of the PetCO(2), even when we compared those with and without ROSC. There was a significant difference in the PetCO(2 )after 1 min of CPR between those patients with ROSC and those without ROSC. The mean value for all patients was significantly higher in the group with asphyxial arrest. In the group with VF/VT arrest there was a significant difference in the initial PetCO(2 )between patients without and with ROSC. In all patients with ROSC the initial PetCO(2 )was higher than 10 mmHg. CONCLUSIONS: The initial PetCO(2 )is significantly higher in asphyxial arrest than in VT/VF cardiac arrest. Regarding asphyxial arrest there is also no difference in values of initial PetCO(2 )between patients with and without ROSC. On the contrary, there is a significant difference in values of the initial PetCO(2 )in the VF/VT cardiac arrest between patients with and without ROSC. This difference could prove to be useful as one of the methods in prehospital diagnostic procedures and attendance of cardiac arrest. For this reason we should always include other clinical and laboratory tests

Double venous drainage through the superior vena cava in minimally invasive aortic valve replacement: a retrospective study

Aim To compare the outcomes of patients who underwent upper mini-sternotomy or right mini-thoracotomy and those who underwent full sternotomy and to report a technical improvement in venous drainage by means of double venous cannulation of the superior vena cava (SVC) in mini surgical procedures. Methods We retrospectively analyzed the outcome of 217 patients who underwent aortic valve replacement through upper mini-sternotomy or right mini-thoracotomy at the Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Slovenia from 1996 till 2010. Cannulation of SVC and right atrial appendage was performed in 142/217 (65%) patients, while in the remaining 75 (35%) patients, double cannulation of SVC was used for venous drainage. The results of patients who underwent mini approaches were compared to 236 patients who underwent full sternotomy for the same purpose from 2009 to 2010 at the same center. Results We found a shorter mean length of intensive care unit stay, less volume chest-tube drainage, shorter crossclamp and cardio pulmonary bypass times, and less postoperative permanent pacemaker implantations in the minimally invasive group patients than in full sternotomy group patients. Using double cannulation of the SVC for venous drainage made venous cannulation in mini approaches easier and eliminated the need for obtaining femoral venous access. Conclusion Our study confirmed that even though technically challenging, upper mini-sternotomy and right minithoracotomy approaches for aortic valve replacement have potential advantages over conventional median sternotomy. They were proved to be safe, efficacious, and can significantly reduce surgical trauma and are therefore particularly valuable in some higher risk, obese, diabetic and elderly patients. Using double cannulation of SVC for venous drainage made venous cannulation easier and eliminated the need for obtaining femoral venous access

Profili i usporedbe sastava tijela vrhunskih odbojkašica

The authors present the profile and comparison of body composition of the female national volleyball team of the Slovak Republic (senior team – SNT, U19 and U17). The body composition was identified with the use of the multi-frequency bioimpedance method (BIA 2000M). The monitored parameters included the amount of lean body mass (LBM), intra- (BCM) and extracellular mass (ECM) and BCM proportion in LBM (CQ), fat mass (FM), the phase angle indicating cell quality (α), total body water (TBW) and its distribution into intra- (ICW) and extracellular liquid (ECW). The authors recorded the values of female volleyball players indicating their good training load and corresponding to the values characterizing highperformance sport even in the category U17, when this team significantly differed from the senior team (SNT) only in FM (p<.05). On the contrary, teams U19 and SNT were significantly different in FM, TBW, α, BCM, ECM/BCM, ICW, ECW and CQ (p<.05). We assume that body composition indicators of the team may relate not only to the state of training load (players’ physical preparedness) but also to the success of the team at important events.U ovom radu autori su predstavili profile i usporedbe tjelesnog sastava ženskih slovačkih nacionalnih odbojkaških ekipa (seniorke-SNT, U19 i U17). Sastav je tijela određen pomoću više-frekvencijske metode bioimpedancije (BIA 2000M). Mjereni su parametri uključili količinu nemasne mase tijela (LBM), unutar- (BCM) i izvanstaničnu masu (ECM) te proporciju BCM u LBM (CQ), masu potkožnog masnog tkiva (FM), kutnu fazu koja je upućivala na kvalitetu stanice (α), ukupnu vodu u tijelu (TBW) i njezinu distribuciju u unutar- (ICW) i izvanstaničnoj tekućini (ECW). Zabilježene vrijednosti kod odbojkašica su upućivale na dobro trenažno opterećenje i korespondirale su s vrijednostima koje karakteriziraju vrhunske sportašice čak i u kategoriji U17, budući da su se odbojkašice U17 statistički značajno razlikovale od seniorki samo u masi potkožnog masnog tkiva (p<.05). Naprotiv, statistički značajne razlike između odbojkašica U19 i seniorki utvrđene su u FM, TBW, α, BCM, ECM/BCM, ICW, ECW i CQ (p<.05). Pretpostavka je autora da pokazatelji sastava tijela pojedine ekipe nisu povezani samo s trenažnim opterećenjem kojem su podvrgnute, odnosno razini kondicijske pripremljenosti igračica, već također i s uspješnošću ekipe na važnim natjecanjima

Physiological demands of indoor wall climbing in children

The study aimed to assess the physiological demands of indoor wall climbing in children. Twenty five children (aged 8–12 years) from a climbing school, with a performance RP (red point) of IV to V+ UIAA (Union Internationale des Associations d’Alpinisme) scale, (5.4 to 5.7 YDS, Yosemite Decimal System and 4a to 5a Sport/French scale), participated in the study. All 25 children climbed the first vertical route (IV UIAA, 5.4 YDS, 4a Sport/French) and ten went on to complete the 110° overhanging route (IV+ UIAA, 5.5 YDS, 4b Sport/French). Both routes were climbed in a top rope style, at a self-selected pace. A portable gas analyser was used to assess the physiological response to the climbs. In addition, the time spent climbing by the children was recorded during the subsequent eight-week period. There were no significant differences found in the peak oxygen consumption between boys and girls, or for the route inclinations, with mean values of around 40 ml·kg-1·min-1. The children also achieved similarly high mean % values of HRmax, of between approximately 81 – 90%. To conclude, a typical children’s climbing session involves short intermittent high intensity climbing, interspersed with longer periods of rest. It is possible that climbing in short intermittent bursts, as seen in the present research, may be considered high-intensity-training (HIT), with sufficient intensity to influence aerobic fitness in children

Multimodal Therapy for the Treatment of Severe Ischemic Stroke Combining Endovascular Embolectomy and Stenting of Long Intracranial Artery Occlusion

Embolic occlusion of cerebral arteries is a major cause for stroke. Intravenous thrombolysis showed positive results in this condition, however even when strict criteria are used, the risk of hemorrhagic transformation is possible. Microsurgical embolectomy has been described earlier. Purpose. We performed multimodal therapy of cerebral artery occlusion. Case Report. We present a case of a 49-year-old female patient who—according to the National Institute of Health Stroke Scale (NIHSS)—was rated as 19 due to acute occlusion of the horizontal segment of the left middle cerebral artery (MCA). After failed i.v. thrombolysis, only a part of the clot could be evacuated by the endovascular approach—without restoration of blood flow. Normal patency of the left MCA was re-established after stenting. Within 72 hours, the patient had an NIHSS score of 14, with a small haematoma in the left hemisphere. Conclusion. In our case multimodal therapy combining i.v. thrombolysis, mechanical disruption of thrombus, MCA stenting and platelet function antagonists, resulted in successful recanalization of the acutely occluded left MCA