Impact of gravitational interaction between the Moon and the Earth on the occurrence of episodes of cardiogenic pulmonary edema in the field

While circadian variation of occurrence of cardiovascular emergencies has been described, it has not been assessed whether fluctuations of gravitational interaction between the Earth and the Moon may induce other types of its variation in time have the similar impact. Therefore, we decided to evaluate whether there is an association between the occurrence of prehospital cardiogenic pulmonary edema (CPE) episodes treated by Emergency Medical Services (EMS) and fluctuations in the intensity of gravitational interaction between the Earth and the Moon. Methods. We extracted all dispatches to CPE episodes from the EMS database of the Central Bohemian Region, Czech Republic, between 2.11.2008 and 1.7.2014. For each episode, the intensity of gravitational interaction between the Moon and the Earth was calculated. The study period was divided into 11 sections of equal duration according to the different intensity of gravitational interaction, and occurrence of CPE was compared among the groups. Results. We observed up to 4,744 episodes of CPE during the study period. Occurrence of CPE episodes was highest in the periods with the weakest intensity of gravitational interaction (≤1.80e1026 N), while in the periods of the most intense gravitational interaction (≥2.26e1026 N), the lowest proportion of CPE cases was observed (23.44 vs. 3.79 %, p <0.001). Conclusions. We identified a significant association between the intensity of gravitational interaction between the Earth and the Moon and occurrence of CPE, treated by our EMS. The weakest intensity was associated with its increased occurrence and vice versa. Further research is required for potential use of this phenomenon in a chronotherapeutic approach to secondary prevention of CPE

Rescuer fatigue does not correlate to energy expenditure during simulated basic life support

It is known that providing basic life support (BLS) may be limited by the physical capabilities of rescuers. The other factor that may affect BLS quality is its energy expenditure. Therefore, we decided to compare the energy expenditure of standard BLS with a compression-ventilation ratio of 30:2 (S-BLS) and compression-only BLS (CO-BLS) and assess the sensation of fatigue and perceived exertion associated with these activities. Methods. We conducted a simulation study on 10 healthy volunteers using a resuscitation manikin. Participants were randomly assigned to start with CO-BLS or with S-BLS, in accordance with recent guidelines. Later, every individual provided the other type of BLS. BLS was terminated in the event of exhaustion, impossibility to retain high-quality BLS or after 30 minutes of BLS. Energy expenditure was expressed as relative oxygen consumption (VO2/kg) and area under the curve of all VO2/kg measurements during each BLS procedure indexed to one minute (AUCVO2/kg min). All participants completed a survey to assess perceived intensity of exertion by Borg, and sensation of general fatigue by visual analogue scale. Results. Maximal VO2/kg (23.16±3.94 vs. 20.17±2.14 ml/kg/min, p=0.049) and AUCVO2/kg min (18.90±3.13 vs. 15.91±2.07 ml/min3; p=0.021) during S-BLS were significantly higher compared to CO-BLS. Conversely, a more intense rate of perceived exertion (16.6±2.0 vs. 13.8±1.2, p=0.001) and sensation of general fatigue (86.5±10.8 vs. 75.0±14.3, p=0.058) were associated with CO-BLS. Neither sensation of general fatigue, nor perceived exertion correlated with energy expenditure. Conclusions. Energy expenditure of S-BLS was higher than of CO-BLS in our study, while sensation of fatigue and perceived exertion reflected the opposite association

Correlation between end-tidal carbon dioxide and the degree of compression of heart cavities measured by transthoracic echocardiography during cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Abstract Background The concept of personalized cardiopulmonary resuscitation (CPR) requires a parameter that reflects its hemodynamic efficiency. While intra-arrest ultrasound is increasingly implemented into the advanced life support, we realized a pre-hospital clinical study to evaluate whether the degree of compression of the right ventricle (RV) and left ventricle (LV) induced by chest compressions during CPR for out-of-hospital cardiac arrest (OHCA) and measured by transthoracic echocardiography correlates with the levels of end-tidal carbon dioxide (EtCO2) measured at the time of echocardiographic investigation. Methods Thirty consecutive patients resuscitated for OHCA were included in the study. Transthoracic echocardiography was performed from a subcostal view during ongoing chest compressions in all of them. This was repeated three times during CPR in each patient, and EtCO2 levels were registered. From each investigation, a video loop was recorded. Afterwards, maximal and minimal diameters of LV and RV were obtained from the recorded loops and the compression index of LV (LVCI) and RV (RVCI) was calculated as (maximal − minimal/maximal diameter) × 100. Maximal compression index (CImax) defined as the value of LVCI or RVCI, whichever was greater was also assessed. Correlations between EtCO2 and LVCI, RVCI, and CImax were expressed as Spearman’s correlation coefficient (r). Results Evaluable echocardiographic records were found in 18 patients, and a total of 52 measurements of all parameters were obtained. Chest compressions induced significant compressions of all observed cardiac cavities (LVCI = 20.6 ± 13.8%, RVCI = 34.5 ± 21.6%, CImax = 37.4 ± 20.2%). We identified positive correlation of EtCO2 with LVCI (r = 0.672, p &lt; 0.001) and RVCI (r = 0.778, p &lt; 0.001). The strongest correlation was between EtCO2 and CImax (r = 0.859, p &lt; 0.001). We identified that a CImax cut-off level of 17.35% predicted to reach an EtCO2 level &gt; 20 mmHg with 100% sensitivity and specificity. Conclusions Evaluable echocardiographic records were reached in most of the patients. EtCO2 positively correlated with all parameters under consideration, while the strongest correlation was found between CImax and EtCO2. Therefore, CImax is a candidate parameter for the guidance of hemodynamic-directed CPR. Trial registration ClinicalTrial.gov, NCT03852225. Registered 21 February 2019 - Retrospectively registered. </jats:sec

Artykuł oryginalnyOcena zmienności przepływu krwi w aorcie jako metoda przewidywania odpowiedzi na obciążenie płynami u spontanicznie oddychających zdrowych osób

Background: Assessment of fluid responsiveness is an important topic in acute cardiology. Echocardiographic measurement of respiratory variations of aortic blood velocity in ventilated shock patients can accurately predict the effect of volume expansion. On the other hand, it remains unclear whether this respiratory variability is a common physiological reaction to hypovolaemia and whether its measurement is applicable also in spontaneously breathing patients. Aim: To assess whether respiratory variability of peak aortic blood flow velocity (DVpeakao) and of aortic velocity time integral (DVTIao) reflects preload-dependent changes of cardiac index (CI) and whether it predicts fluid responsiveness in healthy spontaneously breathing volunteers. Methods: DVpeakao, DVTIao and CI were measured by transthoracic echocardiography in 20 volunteers at baseline and after intravenous administration of furosemide (0.5 mg/kg). Afterwards, volunteers were randomised to rapid intravenous volume expansion (group A) or no expansion (group B) and assessed finally. Results: Hypovolaemia induction was associated with a decrease of CI (from 3.25 &#177; 0.50 to 2.28 &#177; 0.43 l/min/m2, p 15%) with a sensitivity of 89% and specificity of 100%. Conclusions: DVpeakao and DVTIao reflect preload-dependent changes of CI in healthy spontaneously breathing volunteers and predict fluid responsiveness.Wstęp: Ocena odpowiedzi na obciążenie płynami jest istotnym zagadnieniem. Wykazano, że na podstawie echokardiograficznych pomiarów oddechowej zmienności prędkości przepływu krwi w aorcie u chorych we wstrząsie podczas mechanicznej wentylacji można dość dokładnie przewidzieć skutki podania płynów. Nie wiadomo jednak, czy ta oddechowa zmienność jest typową fizjologiczną reakcją na hipowolemię i czy pomiar prędkości przepływu krwi w aorcie jest również użyteczny u chorych oddychających samodzielnie. Cel: Ustalenie, czy oddechowa zmienność szczytowej prędkości przepływu krwi w aorcie (DVpeakao) i całki tej wartości (DVTIao) odzwierciedla zależne od obciążenia wstępnego zmiany w rzucie serca (CI) i czy przewiduje odpowiedź na obciążenie płynami u spontanicznie oddychających zdrowych osób. Metody: Wartości DVpeakao, DVTIao i CI mierzono za pomocą echokardiografii przezklatkowej u 20 zdrowych ochotników przed i po dożylnym podaniu furosemidu w dawce 5 mg/kg. Następnie uczestnicy badania w sposób losowy zostali przydzieleni do jednej z dwóch grup: szybkiego dożylnego podania płynów (grupa A) lub bez obciążenia płynami (grupa B). Wyniki: Wywołana furosemidem hipowolemia spowodowała spadek CI (z 3,25 &#177; 0,50 do 2,28 &#177; 0,43 l/min/m2, p 15%) z czułością 89% i swoistością 100%. Wnioski: Wartości DVpeakao i DVTIao odzwierciedlają zmiany w CI zależne od obciążenia wstępnego u spontanicznie oddychających zdrowych osób i przewidują odpowiedź na obciążenie płynami

Successful Treatment of Refractory Status Asthmaticus With Omalizumab.

Abstract The presented case demonstrates the efficacy of omalizumab as a rescue therapy of refractory status asthmaticus associated with high IgE levels. Omalizumab should be considered in patients with status asthmaticus unresponsive to standard treatment.</jats:p