Therapeutic Hypothermia after Peri-Interventional In-Hospital Cardiac Arrest

Background: Therapeutic hypothermia is recommended by international guidelines for patients after out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation. However, data for patients after in-hospital cardiac arrest (IHCA) are still scarce. Guidelines leave it to the attending physician to decide on the use of hypothermia in IHCA patients.Objective: To determine the use of therapeutic hypothermia in-hospital cardiac arrest.Design: Retrospective case series.Setting: University Hospital of colgne, intensive care units.Subjects: Seven patients admitted to the intensive care unit after peri-interventional IHCA between January and December 2009.Interventions: Therapeutic hypothermia was initiated in all patients with a median delay of five hours.Results: Four out of seven patients (57 %) survived cardiac arrest, but one of these later died due to her primary cause of hospitalisation. The other three patients were discharged without neurological sequelae. There were no serious adverse effects of therapeutic hypothermia.Conclusion: Therapeutic hypothermia after peri-interventional IHCA IHCA is safe and might benefit the patient. This treatment strategy should be taken into consideration until further data are available

Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology

In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on scene, deliver initial drug therapy and transport the patient to the most appropriate (not necessarily the closest) cardiac facility. Primary PCI is the treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI is a valid alternative, according to patient's baseline risk, time from symptoms onset and primary PCI-related delay. Paramedics and nurses have an important role in pre-hospital STEMI care and their empowerment is essential to increase the effectiveness of the system. Strong cooperation between cardiologists and emergency medicine doctors is mandatory for optimal pre-hospital STEMI care. Scientific societies have an important role in guideline implementation as well as in developing quality indicators and performance measures; health care professionals must overcome existing barriers to optimal care together with political and administrative decision maker

Float, explode or sink: postmortem fate of lung-breathing marine vertebrates

What happens after the death of a marine tetrapod in seawater? Palaeontologists and neontologists have claimed that large lung-breathing marine tetrapods such as ichthyosaurs had a lower density than seawater, implying that their carcasses floated at the surface after death and sank subsequently after leakage of putrefaction gases (or ‘‘carcass explosions’’). Such explosions would thus account for the skeletal disarticulation observed frequently in the fossil record. We examined the taphonomy and sedimentary environment of numerous ichthyosaur skeletons and compared them to living marine tetrapods, principally cetaceans, and measured abdominal pressures in human carcasses. Our data and a review of the literature demonstrate that carcasses sink and do not explode (and spread skeletal elements). We argue that the normally slightly negatively buoyant carcasses of ichthyosaurs would have sunk to the sea floor and risen to the surface only when they remained in shallow water above a certain temperature and at a low scavenging rate. Once surfaced, prolonged floating may have occurred and a carcass have decomposed gradually. Our conclusions are of significance to the understanding of the inclusion of carcasses of lung-breathing vertebrates in marine nutrient recycling. The postmortem fate has essential implications for the interpretation of vertebrate fossil preservation (the existence of complete, disarticulated fossil skeletons is not explained by previous hypotheses), palaeobathymetry, the physiology of modern marine lung-breathing tetrapods and their conservation, and the recovery of human bodies from seawater