11 research outputs found
LUCAS Versus Manual Chest Compression During Ambulance Transport : A Hemodynamic Study in a Porcine Model of Cardiac Arrest
Background-Mechanical chest compression (CC) is currently suggested to deliver sustained high-quality CC in a moving ambulance. This study compared the hemodynamic support provided by a mechanical piston device or manual CC during ambulance transport in a porcine model of cardiopulmonary resuscitation. Methods and Results-In a simulated urban ambulance transport, 16 pigs in cardiac arrest were randomized to 18 minutes of mechanical CC with the LUCAS (n=8) or manual CC (n=8). ECG, arterial and right atrial pressure, together with end-tidal CO2 and transthoracic impedance curve were continuously recorded. Arterial lactate was assessed during cardiopulmonary resuscitation and after resuscitation. During the initial 3 minutes of cardiopulmonary resuscitation, the ambulance was stationary, while then proceeded along a predefined itinerary. When the ambulance was stationary, CC-generated hemodynamics were equivalent in the 2 groups. However, during ambulance transport, arterial and coronary perfusion pressure, and end-tidal CO(2 )were significantly higher with mechanical CC compared with manual CC (coronary perfusion pressure: 43 +/- 4 versus 18 +/- 4 mmHg; end-tidal CO2: 31 +/- 2 versus 19 +/- 2 mmHg, P Conclusions-This model adds evidence in favor of the use of mechanical devices to provide ongoing high-quality CC and tissue perfusion during ambulance transport.Peer reviewe
Comparative Analysis of Illicit Supply Network Structure and Operations: Cocaine, Wildlife, and Sand
Illicit supply networks (ISNs) are composed of coordinated human actors that source, transit, and distribute illicitly traded goods to consumers, while also creating widespread social and environmental harms. Despite growing documentation of ISNs and their impacts, efforts to understand and disrupt ISNs remain insufficient due to the persistent lack of knowledge con-necting a given ISN’s modus operandi and its patterns of activity in space and time. The core challenge is that the data and knowledge needed to integrate it remain fragmented and/or compartmentalized across disciplines, research groups, and agencies tasked with understanding or monitoring one or a few specific ISNs. One path forward is to conduct comparative analyses of multiple diverse ISNs. We present and apply a conceptual framework for linking ISN modus operandi to spatial-temporal dynamics and patterns of activity. We demonstrate this through a comparative analysis of three ISNs – cocaine, illegally traded wildlife, and illegally mined sand – which range from well-established to emergent, global to domestic in geographic scope, and fully illicit to de facto legal. The proposed framework revealed consistent traits related to geographic price structure, value capture at different supply chain stages, and key differ-ences among ISN structure and operation related to commodity characteristics and their relative illicitness. Despite the diversity of commodities and ISN attributes compared, social and environmental harms inflicted by the illicit activity consistently become more widespread with increasing law enforcement disruption. Drawing on these lessons from diverse ISNs, which varied in their histories and current sophistication, possible changes in the structure and function of nascent and/or low salience ISNs may be anticipated if future conditions or law enforcement pressure change
Sulfide Catabolism Ameliorates Hypoxic Brain Injury
The mammalian brain is highly vulnerable to oxygen deprivation, yet the mechanism underlying the brain’s sensitivity to hypoxia is incompletely understood. Hypoxia induces accumulation of hydrogen sulfide, a gas that inhibits mitochondrial respiration. Here, we show that, in mice, rats, and naturally hypoxia-tolerant ground squirrels, the sensitivity of the brain to hypoxia is inversely related to the levels of sulfide:quinone oxidoreductase (SQOR) and the capacity to catabolize sulfide. Silencing SQOR increased the sensitivity of the brain to hypoxia, whereas neuron-specific SQOR expression prevented hypoxia-induced sulfide accumulation, bioenergetic failure, and ischemic brain injury. Excluding SQOR from mitochondria increased sensitivity to hypoxia not only in the brain but also in heart and liver. Pharmacological scavenging of sulfide maintained mitochondrial respiration in hypoxic neurons and made mice resistant to hypoxia. These results illuminate the critical role of sulfide catabolism in energy homeostasis during hypoxia and identify a therapeutic target for ischemic brain injury
Ivabradine: potential clinical applications in critically ill patients
It has been extensively demonstrated that an
elevated heart rate is a modifiable, independent risk factor
for cardiovascular events. A high heart rate increases
myocardial oxygen consumption and reduces diastolic
perfusion time. It can also increase ventricular diastolic
pressures and induce ventricular arrhythmias. Critical care
patients are prone to develop a stress induced cardiac
impairment and consequently an increase in sympathetic
tone. This in turn increases heart rate. In this setting,
however, heart rate lowering might be difficult because the
effects of inotropic drugs could be hindered by heart rate
reducing drugs like beta-blockers. Ivabradine is a new
selective antagonist of funny channels. It lowers heart rate,
reducing the diastolic depolarization slope. Moreover,
ivabradine is not active on sympathetic pathways, thus
avoiding any interference with inotropic amines. We
reviewed the literature available regarding heart rate control
in critical care patients, focusing our interest on the use
of ivabradine to assess the potential benefits of the drug in
this particular setting
Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium
BackgroundPerioperative cardiac arrest is a rare complication with an
incidence of around 1 in 1400 cases, but it carries a high burden of
mortality reaching up to 70% at 30 days. Despite its specificities,
guidelines for treatment of perioperative cardiac arrest are lacking.
Gathering the available literature may improve quality of care and
outcome of patients.MethodsThe PERIOPCA Task Force identified major
clinical questions about the management of perioperative cardiac arrest
and framed them into the therapy population [P], intervention [I],
comparator [C], and outcome [O] (PICO) format. Systematic searches
of PubMed, Embase, and the Cochrane Library for articles published until
September 2020 were performed. Consensus-based treatment recommendations
were created using the Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) system. The strength of consensus
among the Task Force members about the recommendations was assessed
through a modified Delphi consensus process.ResultsTwenty-two PICO
questions were addressed, and the recommendations were validated in two
Delphi rounds. A summary of evidence for each outcome is reported and
accompanied by an overall assessment of the evidence to guide healthcare
providers.ConclusionsThe main limitations of our work lie in the
scarcity of good quality evidence on this topic. Still, these
recommendations provide a basis for decision making, as well as a guide
for future research on perioperative cardiac arrest
Clinical practice recommendations on the management of perioperative cardiac arrest: A report from the PERIOPCA Consortium
International audienceBackground: Perioperative cardiac arrest is a rare complication with an incidence of around 1 in 1400 cases, but it carries a high burden of mortality reaching up to 70% at 30 days. Despite its specificities, guidelines for treatment of perioperative cardiac arrest are lacking. Gathering the available literature may improve quality of care and outcome of patients. Methods: The PERIOPCA Task Force identified major clinical questions about the management of perioperative cardiac arrest and framed them into the therapy population [P], intervention [I], comparator [C], and outcome [O] (PICO) format. Systematic searches of PubMed, Embase, and the Cochrane Library for articles published until September 2020 were performed. Consensus-based treatment recommendations were created using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. The strength of consensus among the Task Force members about the recommendations was assessed through a modified Delphi consensus process. Results: Twenty-two PICO questions were addressed, and the recommendations were validated in two Delphi rounds. A summary of evidence for each outcome is reported and accompanied by an overall assessment of the evidence to guide healthcare providers. Conclusions: The main limitations of our work lie in the scarcity of good quality evidence on this topic. Still, these recommendations provide a basis for decision making, as well as a guide for future research on perioperative cardiac arrest
Noninvasive Ventilatory Support of COVID-19 Patients Outside the Intensive Care Units (WARd-COVID)
Treatment with non-invasive ventilation (NIV) in COVID-19 is frequent. Shortage of Intensive care unit (ICU) beds led clinicians to deliver NIV also outside intensive care units (ICUs). Data about the use of NIV in COVID-19 is limited