Роль фактора некроза опухоли-альфа в прогнозировании тяжести и исхода сепсиса у пациентов неотложного отделения с системным воспалением

Aim of the study was to determine whether the TNF-a levels, proximal inflammatory mediator, in septic patients presenting to the emergency department (ED) and admitted to the intensive care unit (ICU) are associated with progression to severe sepsis, septic shock or death. Material and methods. A retrospective observational study was performed on a sample of one hundred adult subjects presenting to the ED with systemic inflammatory response syndrome of 2 etiologies: presumed (and later confirmed in the ICU and/or operating room) severe acute pancreatitis or generalized peritonitis. Blood TNF-a samples measurements were taken shortly after ED admission. TNF-a was measured by commercial ELISA test in plasma. Results. Mean values of TNF-a on admission (day zero, in ED) were 191,5-fold lower in group with septic shock compared to severe sepsis group and were 63-fold higher in survivors (p<0.01). The area under the curve (AUC) for the TNF-a plots for severity of clinical status was 0.813 and for outcome 0.834. Patients with TNF-a levels lower than 7.95 pg/mL had a 3.2-fold higher probability of septic shock development than those with higher values, at the cutoff level sensitivity was 83,9% and specificity 72,5%. Patients with TNF-a levels higher than 10.5 pg/mL had a 4.8-fold higher probability to survive than those with lower values, at the cutoff level sensitivity was 83,0% and specificity 77,4%. Conclusion: Decreasing in TNF-a concentration leads to the septic shock development and fatal outcome. TNF-a is very good predictor of sepsis severity and outcome. Key words: sepsis, tumor necrosis factor-alpha, emergency medical services, survival rate, severity of illness index.Цель исследования — определить, связаны ли уровни ФНО-a, ключевого медиатора воспаления, у пациентов с сепсисом, поступающих в отделение неотложной помощи и переводящихся в отделение реанимации, с прогрессированием его до тяжелого сепсиса, септического шока и смерти. Материал и методы. Ретроспективное обсервационное исследование было выполнено на выборке в 100 взрослых человек, поступивших в неотложное отделение с признаками системного воспаления двух возможных этиологий: тяжелый острый панкреатит (предполагаемый, а затем подтвержденный в отделении реанимации и/или операционной) или общий перитонит. Производили измерения ФНО-a в крови сразу после поступления. ФНО-a измеряли коммерчески доступным ELISA-методом в плазме крови. Результаты. Средние уровни ФНО-a при поступлении (день 0, в неотложном отделении) были в 191,5 раз ниже в группе с септическим шоком по сравнению с группой тяжелого сепсиса и в 63 раза выше у выживших (

Kids Save Lives ERC-Position Statement on School Children Education in the Resuscitation "Hands that help Training children is Training for Life"

Peer reviewe

Addition of glucagon to adrenaline improves hemodynamics in a porcine model of prolonged ventricular fibrillation

Objective Cardiac arrest is a daunting medical emergency. The aim of the present study was to assess whether the combination of adrenaline and glucagon would improve initial resuscitation success, 48-hour survival, and neurologic outcome compared with adrenaline alone in a porcine model of ventricular fibrillation. Methods Ventricular fibrillation was induced in 20 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 minutes. The animals were randomized to receive adrenaline alone (n = 10, group C) and adrenaline plus glucagon (n = 10, group G). All animals were resuscitated according to the 2010 European Resuscitation Council guidelines. Hemodynamic variables were measured before arrest, during arrest and resuscitation, and during the first 60 minutes after return of spontaneous circulation. Survival and a neurologic alertness score were measured at 48 hours after return of spontaneous circulation. Results Return of spontaneous circulation was achieved in 8 animals (80%) from group C and 10 animals (100%) from group G (P =.198). A significant gradual increase in coronary perfusion pressure and diastolic aortic pressure over time, which started 1 minute after the onset of cardiopulmonary resuscitation, was observed. Three animals (30%) from group C and 9 animals (90%) from group G survived after 48 hours (P =.006), whereas neurologic examination was significantly better in the animals of group G (P <.001). Conclusions In this porcine model of prolonged ventricular fibrillation, the addition of glucagon to adrenaline improves hemodynamics during resuscitation and early postresuscitation period and may increase survival. © 2013 Elsevier Inc

Influence of electromagnetic interference on AED function in metro stations

Although automated external defibrillators (AEDs) are available for public responders in metro stations, electromagnetic interference (EMI) of metro stations and cellular telephones may weaken the signal quality of an AED. We assessed the influence of metro stations EMI, with or without the interference of digital cellular telephones, on the performance of AED. We observed the most significant interference on the rhythm analysis with the combination of the incoming train and cellular telephone operation

Влияние сердечно-легочной реанимации с поддержкой диспетчером скорой медицинской помощи на восстановление эффективного кровообращения и краткосрочную выживаемость

The Aim: analysis of the influence of dispatcher assistance during cardiopulmonary resuscitation (CPR) of patients with out-of-hospital cardiac arrest (OHCA) in achieving return of spontaneous circulation (ROSC), better survival at the scene, survival to discharge, and 30-day survival.Materials and methods. This study includes epidemiological data on OHCA collected by the study protocol of the European Resuscitation Council's EuReCa_ONE study during the period October 1, 2014 — December 31, 2019. Statistical analysis was performed using SPSS Statistics v26 and GraphPad Prism v8 software packages.Results. This study included 288 patients with OHCA where CPR was provided by bystander. Dispatcher-assisted CPR (DA-CPR) occurred in 56.9% of those patients and ROSC was achieved in 31.3% of cases. Forty-four patients were hospitalized and 16 of those survived until discharge. There was no influence of dispatcher assistance on ROSC, although it resulted in slightly greater risk of the absence of ROSC (OR=1.063). Higher mortality rate to discharge occurred in DA-CPR group (P=0.013). No statistical significance was observed between DA-CPR and non-DA-CPR groups in terms of death at the scene, and 30-day survival. Dispatcher assistance during the initial CPR in hospitalized OHCA patients was a significant predictor of death outcome during hospitalization (P=0.017, OR=5.500).Conclusions. There is no significant association between the presence/absence of dispatcher assistance and ROSC or 30-day survival rate. In contrast, DA-CPR was non-significantly associated with slightly higher odds for the absence of ROSC. DA-CPR was also associated with lower survival-to-discharge rates in hospitalized OHCA patients. The study findings are the base/ground which highlights the need of implementation of existing and development of new guidelines regarding high-quality professional training of EMS dispatchers as well as basic life support education of general population.Цель: анализ влияния помощи диспетчера во время сердечно-легочной реанимации (СЛР) пациентов с внебольничной остановкой сердца (ВБОС) на восстановление эффективного кровообращения (ВЭК), улучшение выживаемости на месте произошедшей остановки кровообращения, выживаемость до выписки и выживаемость в течение 30 дней.Материалы и методы. Данное исследование включило эпидемиологические данные по ВБОС, собранные в соответствии с протоколом исследования Европейского совета по реанимации EuReCa_ONE в период с 1 октября 2014 года по 31 декабря 2019 года. Статистический анализ проводили с использованием программных пакетов SPSS Statistics v26 и GraphPad Prism v8.Результаты. В исследование включили 288 пациентов с ВБОС, у которых сердечно-легочная реанимация была проведена случайным очевидцем. СЛР с помощью диспетчера (СЛРПД) была проведена у 56,9% пациентов, а ВЭК было достигнуто в 31,3% случаев. Сорок четыре пациента были госпитализированы, и 16 из них были живы к моменту выписки. Помощь диспетчера не повлияла на ВЭК, хотя и привела к несколько большему риску отсутствия ВЭК (OR=1,063). Более высокую смертность в период до выписки наблюдали в группе СЛРПД (p=0,013). Различия между группами СЛРПД и СЛР без ПД по смертности на месте остановки кровообращения и 30-дневной выживаемости были незначимы. Помощь диспетчера во время базовых реанимационных мероприятий у госпитализированных впоследствии пациентов с ВБОС оказалась значимым предиктором смертельного исхода в течении периода госпитализации (p=0,017, ОШ 5,500).Заключение. Связь между наличием/отсутствием помощи диспетчера и ВЭК или 30-дневной выживаемостью отсутствует. СЛРПД незначимо ассоциируется с более высокими шансами на отсутствие восстановления кровообращения. СЛРПД также была связана с более низкими показателями выживаемости до выписки у госпитализированных пациентов с ВБОС. Результаты исследования являются основанием для внедрения существующих и разработки новых рекомендаций по высококачественной профессиональной подготовке диспетчеров СМП, а также по обучению населения оказанию базовых реанимационных мероприятий.

European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions

These European Resuscitation Council Ethics guidelines provide evidence-based recommendations for the ethical, routine practice of resuscitation and end-of-life care of adults and children. The guideline primarily focus on major ethical practice interventions (i.e. advance directives, advance care planning, and shared decision making), decision making regarding resuscitation, education, and research. These areas are tightly related to the application of the principles of bioethics in the practice of resuscitation and end-of-life care. © 202

New and Optimized Magnetization Scheme for the Baby Magnetized Iron Neutrino Detector at J-PARC

The Baby-MIND (magnetized iron neutrino detector) collaboration is building a muon detector to be installed downstream of the WAGASCI experiment at J-PARC (Japan). Due to the challenging timeline and space constraints for the installation in the ND280 pit, an innovative magnetization scheme has been developed for the iron plates. The magnetization scheme optimizes flux return for minimum stray field and operating current, while maximizing the useful tracking area with $B > 1.5$ T. The 33 iron plates of the detector are individually magnetized by coils wound on their surface by “sewing” an aluminum conductor through slits cut in the plates. In this paper, we present the details of the magnetization scheme and coil winding procedure as well as the results of magnetization tests performed on a prototype module and the first eighteen detector plates