Sudden Cardiac Arrest: ECG Repolarization After Resuscitation.

International audienceSudden Cardiac Arrest and ECG Repolarization. Introduction: Early repolarization (ERep) abnormalities on electrocardiogram (ECG) are common immediately following cardiac arrest. We characterized and correlated electrocardiographic repolarization abnormalities immediately after cardiac arrest with acute coronary angiography. Methods and Results: We studied 225 consecutive patients presenting with out-of-hospital cardiac arrest. All these patients had successful cardiopulmonary resuscitation and acute coronary angiography. The first ECG recorded after successful resuscitation was analyzed by two independent cardiologists. Patients were categorized according to their repolarization pattern. Pattern 1: No ST segment elevation or ERep. Pattern 2: ST segment elevation without ERep. Pattern 3: ST segment elevation and ERep. Pattern 4: ERep only. Patterns 1, 2, 3, and 4 were found in 112 (50%), 74 (33%), 19 (8%), and 20 (9%) patients, respectively. Cardiac arrest was due to acute myocardial ischemia in 45%, 82%, 39%, and 15% of patients in groups 1, 2, 3 and 4, respectively (P < 0.0001). Sensitivity and specificity of pattern 2 was 50% and 88%, respectively, for acute coronary lesion, whereas isolated ERep pattern occurred in 9% of cases and was associated with a nonischemic event (80%). Among 65 patients (29%) who survived, 7% of patients with pattern 1, 13% with pattern 2, 60% with pattern 3, and 88% with pattern 4 exhibited ERep on ECG during the follow-up. Conclusion: In the context of cardiac resuscitation, an ECG with ST elevation favors acute myocardial infarction, whereas the presence of ERep is a marker of a nonischemic event and future ERep syndrome. (J Cardiovasc Electrophysiol, Vol. 22, pp. 131-136, February 2011)

New Hosts of The Lassa Virus.

Lassa virus (LASV) causes a deadly haemorrhagic fever in humans, killing several thousand people in West Africa annually. For 40 years, the Natal multimammate rat, Mastomys natalensis, has been assumed to be the sole host of LASV. We found evidence that LASV is also hosted by other rodent species: the African wood mouse Hylomyscus pamfi in Nigeria, and the Guinea multimammate mouse Mastomys erythroleucus in both Nigeria and Guinea. Virus strains from these animals were isolated in the BSL-4 laboratory and fully sequenced. Phylogenetic analyses of viral genes coding for glycoprotein, nucleoprotein, polymerase and matrix protein show that Lassa strains detected in M. erythroleucus belong to lineages III and IV. The strain from H. pamfi clusters close to lineage I (for S gene) and between II &III (for L gene). Discovery of new rodent hosts has implications for LASV evolution and its spread into new areas within West Africa

Haemodynamic response to crystalloids or colloids in shock: an exploratory subgroup analysis of a randomised controlled trial

for the CRISTAL InvestigatorsInternational audienceObjective To compare the haemodynamic effect of crystalloids and colloids during acute severe hypovolaemic shock.Design Exploratory subgroup analysis of a multicentre randomised controlled trial (Colloids Versus Crystalloids for the Resuscitation of the Critically Ill, CRISTAL, ClinicalTrials.gov NCT00318942).Setting CRISTAL was conducted in intensive care units in Europe, North Africa and Canada.Participants Current analysis included all patients who had a pulmonary artery catheter in place at randomisation. 220 patients (117 received crystalloids vs 103 colloids) underwent pulmonary artery catheterisation.Intervention Crystalloids versus colloids for fluid resuscitation in hypovolaemic shock.Outcome measures Haemodynamic data were collected at the time of randomisation and subsequently on days 1, 2, 3, 4, 5, 6 and 7.Results Median cumulative volume of fluid administered during the first 7 days was higher in the crystalloids group than in the colloids group (3500 (2000–6000) vs 2500 (1000–4000) mL, p=0.01). Patients in the colloids arm exhibited a lower heart rate over time compared with those allocated to the crystalloids arm (p=0.014). There was no significant difference in Cardiac Index (p=0.053), mean blood pressure (p=0.4), arterial lactates (p=0.9) or global Sequential Organ Failure Assessment score (p=0.3) over time between arms.Conclusions During acute severe hypovolaemic shock, patients monitored by a pulmonary artery catheter achieved broadly similar haemodynamic outcomes, using lower volumes of colloids than crystalloids. The heart rate was lower in the colloids arm