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Stefek Grmec - One of the best experts on this subject based on the ideXlab platform.
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the dynamic pattern of end tidal carbon dioxide during cardiopulmonary resuscitation difference between Asphyxial cardiac arrest and ventricular fibrillation pulseless ventricular tachycardia cardiac arrest
Critical Care, 2011Co-Authors: Miljenko Križmaric, Stefek GrmecAbstract:Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in Asphyxial arrest than in ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) cardiac arrest. In this study we sought to evaluate the pattern of PetCO2 changes in cardiac arrest caused by VF/VT and Asphyxial cardiac arrest in patients who were resuscitated according to new 2005 guidelines. The study included two cohorts of patients: cardiac arrest due to Asphyxia with initial rhythm asystole or pulseless electrical activity (PEA), and cardiac arrest due to arrhythmia with initial rhythm VF or pulseless VT. PetCO2 was measured for both groups immediately after intubation and repeatedly every minute, both for patients with or without return of spontaneous circulation (ROSC). We compared the dynamic pattern of PetCO2 between groups. Between June 2006 and June 2009 resuscitation was attempted in 325 patients and in this study we included 51 patients with Asphyxial cardiac arrest and 63 patients with VF/VT cardiac arrest. The initial values of PetCO2 were significantly higher in the group with Asphyxial cardiac arrest (6.74 ± 4.22 kilopascals (kPa) versus 4.51 ± 2.47 kPa; P = 0.004). In the group with Asphyxial cardiac arrest, the initial values of PetCO2 did not show a significant difference when we compared patients with and without ROSC (6.96 ± 3.63 kPa versus 5.77 ± 4.64 kPa; P = 0.313). We confirmed significantly higher initial PetCO2 values for those with ROSC in the group with primary cardiac arrest (4.62 ± 2.46 kPa versus 3.29 ± 1.76 kPa; P = 0.041). A significant difference in PetCO2 values for those with and without ROSC was achieved after five minutes of CPR in both groups. In all patients with ROSC the initial PetCO2 was again higher than 1.33 kPa. The dynamic pattern of PetCO2 values during out-of-hospital CPR showed higher values of PetCO2 in the first two minutes of CPR in Asphyxia, and a prognostic value of initial PetCO2 only in primary VF/VT cardiac arrest. A prognostic value of PetCO2 for ROSC was achieved after the fifth minute of CPR in both groups and remained present until final values. This difference seems to be a useful criterion in pre-hospital diagnostic procedures and attendance of cardiac arrest.
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Difference in end-tidal CO_2 between Asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest in the prehospital setting
Critical Care, 2003Co-Authors: Stefek Grmec, Katja Lah, Ksenija Tušek-buncAbstract:Introduction There has been increased interest in the use of capnometry in recent years. During cardiopulmonary resuscitation (CPR), the partial pressure of end-tidal carbon dioxide (PetCO_2) correlates with cardiac output and, consequently, it has a prognostic value in CPR. This study was undertaken to compare the initial PetCO_2 and the PetCO_2 after 1 min during CPR in Asphyxial cardiac arrest versus primary cardiac arrest. Methods The prospective observational study included two groups of patients: cardiac arrest due to Asphyxia with initial rhythm asystole or pulseless electrical activity, and cardiac arrest due to acute myocardial infarction or malignant arrhythmias with initial rhythm ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The PetCO_2 was measured for both groups immediately after intubation and then repeatedly every minute, both for patients with and without return of spontaneous circulation (ROSC). Results We analyzed 44 patients with Asphyxial cardiac arrest and 141 patients with primary cardiac arrest. The first group showed no significant difference in the initial value of the PetCO_2, even when we compared those with and without ROSC. There was a significant difference in the PetCO_2 after 1 min of CPR between those patients with ROSC and those without ROSC. The mean value for all patients was significantly higher in the group with Asphyxial arrest. In the group with VF/VT arrest there was a significant difference in the initial PetCO_2 between patients without and with ROSC. In all patients with ROSC the initial PetCO_2 was higher than 10 mmHg. Conclusions The initial PetCO_2 is significantly higher in Asphyxial arrest than in VT/VF cardiac arrest. Regarding Asphyxial arrest there is also no difference in values of initial PetCO_2 between patients with and without ROSC. On the contrary, there is a significant difference in values of the initial PetCO_2 in the VF/VT cardiac arrest between patients with and without ROSC. This difference could prove to be useful as one of the methods in prehospital diagnostic procedures and attendance of cardiac arrest. For this reason we should always include other clinical and laboratory tests.
Ksenija Tušek-bunc - One of the best experts on this subject based on the ideXlab platform.
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Difference in end-tidal CO_2 between Asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest in the prehospital setting
Critical Care, 2003Co-Authors: Stefek Grmec, Katja Lah, Ksenija Tušek-buncAbstract:Introduction There has been increased interest in the use of capnometry in recent years. During cardiopulmonary resuscitation (CPR), the partial pressure of end-tidal carbon dioxide (PetCO_2) correlates with cardiac output and, consequently, it has a prognostic value in CPR. This study was undertaken to compare the initial PetCO_2 and the PetCO_2 after 1 min during CPR in Asphyxial cardiac arrest versus primary cardiac arrest. Methods The prospective observational study included two groups of patients: cardiac arrest due to Asphyxia with initial rhythm asystole or pulseless electrical activity, and cardiac arrest due to acute myocardial infarction or malignant arrhythmias with initial rhythm ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The PetCO_2 was measured for both groups immediately after intubation and then repeatedly every minute, both for patients with and without return of spontaneous circulation (ROSC). Results We analyzed 44 patients with Asphyxial cardiac arrest and 141 patients with primary cardiac arrest. The first group showed no significant difference in the initial value of the PetCO_2, even when we compared those with and without ROSC. There was a significant difference in the PetCO_2 after 1 min of CPR between those patients with ROSC and those without ROSC. The mean value for all patients was significantly higher in the group with Asphyxial arrest. In the group with VF/VT arrest there was a significant difference in the initial PetCO_2 between patients without and with ROSC. In all patients with ROSC the initial PetCO_2 was higher than 10 mmHg. Conclusions The initial PetCO_2 is significantly higher in Asphyxial arrest than in VT/VF cardiac arrest. Regarding Asphyxial arrest there is also no difference in values of initial PetCO_2 between patients with and without ROSC. On the contrary, there is a significant difference in values of the initial PetCO_2 in the VF/VT cardiac arrest between patients with and without ROSC. This difference could prove to be useful as one of the methods in prehospital diagnostic procedures and attendance of cardiac arrest. For this reason we should always include other clinical and laboratory tests.
Jeffrey M. Gidday - One of the best experts on this subject based on the ideXlab platform.
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reduction of leukocyte microvascular adherence and preservation of blood brain barrier function by superoxide lowering therapies in a piglet model of neonatal Asphyxia
Frontiers in Neurology, 2019Co-Authors: Jacob B Ruden, Ernesto R. Gonzales, Kevin L Quick, Aarti R Shah, T S Park, Nan Kennedy, Laura L Dugan, Jeffrey M. GiddayAbstract:Background: Asphyxia is the most common cause of brain damage in newborns. Substantial evidence indicates that leukocyte recruitment in the cerebral vasculature during Asphyxia contributes to this damage. We tested the hypothesis that superoxide radical ( O2⋅_ ) promotes an acute post-Asphyxial inflammatory response and blood-brain barrier (BBB) breakdown. We investigated the effects of removing O2⋅_ by superoxide dismutase (SOD) or C3, the cell-permeable SOD mimetic, in protecting against Asphyxia-related leukocyte recruitment. We also tested the hypothesis that xanthine oxidase activity is one source of this radical. Methods: Anesthetized piglets were tracheostomized, ventilated, and equipped with closed cranial windows for the assessment of post-Asphyxial rhodamine 6G-labeled leukocyte-endothelial adherence and microvascular permeability to sodium fluorescein in cortical venules. Asphyxia was induced by discontinuing ventilation. SOD and C3 were administered by cortical superfusion. The xanthine oxidase inhibitor oxypurinol was administered intravenously. Results: Leukocyte-venular adherence significantly increased during the initial 2 h of post-Asphyxial reperfusion. BBB permeability was also elevated relative to non-Asphyxial controls. Inhibition of O2⋅_ production by oxypurinol, or elimination of O2⋅_ by SOD or C3, significantly reduced rhodamine 6G-labeled leukocyte-endothelial adherence and improved BBB integrity, as measured by sodium fluorescein leak from cerebral microvessels. Conclusion: Using three different strategies to either prevent formation or enhance elimination of O2⋅_ during the post-Asphyxial period, we saw both reduced leukocyte adherence and preserved BBB function with treatment. These findings suggest that agents which lower O2⋅_ in brain may be attractive new therapeutic interventions for the protection of the neonatal brain following Asphyxia.
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hydroxyethyl starch reduces leukocyte adherence and vascular injury in the newborn pig cerebral circulation after Asphyxia
Stroke, 2000Co-Authors: Stuart S. Kaplan, Tae Sung Park, Ernesto R. Gonzales, Jeffrey M. GiddayAbstract:Background and Purpose —Hydroxyethyl starch (HES) has beneficial effects on ischemic brain injury; however, its mechanism of action remains unclear. The present study was undertaken to test the hypothesis that HES can attenuate increases in leukocyte adherence and vascular permeability in the cerebral vasculature after global cerebral ischemia induced by Asphyxia. Methods —Pial venular leukocyte adherence and permeability to sodium fluorescein were quantified in anesthetized newborn piglets by in situ fluorescence videomicroscopy through closed cranial windows during basal conditions and during 2 hours of reperfusion after global ischemia induced by 9 minutes of Asphyxia. Experimental animals received HES after the Asphyxial insult (10% HES 257/0.47, 600 mg/kg IV bolus 5 minutes after Asphyxia, followed by 600 mg/kg per hour IV drip during reperfusion; n=9). Results —A progressive and significant ( P <0.05) increase in adherent leukocytes was observed during the initial 2 hours of reperfusion after Asphyxia compared with nonAsphyxial controls. In this model, vascular injury, as determined by significant ( P <0.05) increases in fluorescein permeability at 2 hours of reperfusion, is largely dependent on adherent leukocytes. HES significantly reduced ( P <0.05) leukocyte adherence at 1 hour and 2 hours of reperfusion and reduced fluorescein permeability at 2 hours. HES did not change hematocrit or alter pial arteriolar diameter. Conclusions —These findings indicate that a vascular anti-inflammatory action may underlie the beneficial effects of HES in global cerebral ischemia secondary to Asphyxia. Since this compound is well tolerated by patients, future preclinical and clinical studies may reveal improvements in functional outcome with the early introduction of this or similar agents after perinatal Asphyxia or global ischemia.
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Hydroxyethyl Starch Reduces Leukocyte Adherence and Vascular Injury in the Newborn Pig Cerebral Circulation After Asphyxia
Stroke, 2000Co-Authors: Stuart S. Kaplan, Tae Sung Park, Ernesto R. Gonzales, Jeffrey M. GiddayAbstract:Background and Purpose —Hydroxyethyl starch (HES) has beneficial effects on ischemic brain injury; however, its mechanism of action remains unclear. The present study was undertaken to test the hypothesis that HES can attenuate increases in leukocyte adherence and vascular permeability in the cerebral vasculature after global cerebral ischemia induced by Asphyxia. Methods —Pial venular leukocyte adherence and permeability to sodium fluorescein were quantified in anesthetized newborn piglets by in situ fluorescence videomicroscopy through closed cranial windows during basal conditions and during 2 hours of reperfusion after global ischemia induced by 9 minutes of Asphyxia. Experimental animals received HES after the Asphyxial insult (10% HES 257/0.47, 600 mg/kg IV bolus 5 minutes after Asphyxia, followed by 600 mg/kg per hour IV drip during reperfusion; n=9). Results —A progressive and significant ( P
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modulation of basal and postischemic leukocyte endothelial adherence by nitric oxide
Stroke, 1998Co-Authors: Jeffrey M. Gidday, Aarti R Shah, T S Park, Ernesto R. GonzalesAbstract:Background and Purpose —Recent studies indicate that leukocytes are important contributors to secondary vascular and parenchymal injury after cerebral ischemia. The present study was undertaken to define nitric oxide (NO)−based mechanisms that regulate leukocyte-endothelial interactions in the cerebral vasculature, how these mechanisms are affected by cerebral ischemia, and whether NO-based therapies can affect postischemic leukocyte dynamics. Methods —Leukocyte adherence to pial venules of anesthetized newborn piglets was quantified by in situ fluorescence videomicroscopy through closed cranial windows during basal conditions and during reperfusion after 9 minutes of Asphyxia. Nitric oxide synthase (NOS) was inhibited by local window superfusion of l-nitroarginine; superfusion of sodium nitroprusside was used to donate NO. Results —Local inhibition of NOS under resting conditions increased leukocyte-endothelial adherence 2.2-fold and 3.9-fold over baseline values after 1 hour and 2 hours, respectively; this response was completely blocked by cosuperfusion with l-arginine. Cosuperfusion of superoxide dismutase reversed l-nitroarginine−induced leukocyte adherence by 89% and 63% at these respective time points. The extent of acute leukocyte adherence elicited by NOS inhibition was similar in magnitude to that observed during the initial 2 hours of reperfusion after Asphyxia. Leukocyte adherence was not additionally increased in asphyxic animals treated with l-nitroarginine. Sodium nitroprusside robustly inhibited Asphyxia-induced leukocyte adherence back to control levels. Conclusions —NO exerts a tonic antiadherent effect in the cerebral microcirculation by inactivation of adherence-promoting superoxide radical formation. Cerebral ischemia is associated with an inhibition of NOS or lower levels of NO, which results in leukocyte-endothelial adherence that can be prevented by NO donors. The latter may be useful therapeutically to prevent the purported vascular and parenchymal dysfunction and injury caused by activated leukocytes in ischemic brain.
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cd18 dependent leukocyte adherence and vascular injury in pig cerebral circulation after ischemia
American Journal of Physiology-heart and Circulatory Physiology, 1997Co-Authors: Jeffrey M. Gidday, Tae Sung Park, Ernesto R. Gonzales, Joel W BeetschAbstract:Recent accumulating evidence indicates that leukocytes contribute importantly to ischemic brain injury. Although large numbers of leukocytes are present in the ischemic territory of reperfused brain 24-48 h after the ischemic insult, little is known of the acute inflammatory response to cerebral ischemia, particularly regarding the time course and magnitude of leukocyte adherence to cerebrovascular endothelium and the functional consequences of such adherence. To study these issues, we developed an epifluorescence videomicroscopy system for observing and quantifying the dynamic behavior of rhodamine-labeled leukocytes in the cerebrovascular microcirculation. Anesthetized piglets equipped with closed cranial windows were used in these investigations. During the initial 2 h of reperfusion after 9 min of Asphyxia (n = 6), a marked, progressive increase in adherent leukocytes was noted in cerebral postcapillary venules that was significantly greater in magnitude than that seen in nonasphyxic, time-matched controls (n = 8). A similar response was observed after complete global ischemia of 10 min duration. A significant increase in sodium fluorescein permeability was also measured at 2 h of reperfusion in asphyxic animals. Pretreating a separate asphyxic animal group (n = 7) with a monoclonal antibody to the leukocyte adhesion glycoprotein complex CD11/CD18 severely attenuated both leukocyte adherence and the increase in vascular permeability. These results provide evidence that adherent leukocytes contribute to disruption of endothelial integrity during early reperfusion after global ischemic insults, the inhibition of which may reduce the vasogenic edema that occurs early during reperfusion after birth Asphyxia, stroke, and cardiac arrest.
Miljenko Križmaric - One of the best experts on this subject based on the ideXlab platform.
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the dynamic pattern of end tidal carbon dioxide during cardiopulmonary resuscitation difference between Asphyxial cardiac arrest and ventricular fibrillation pulseless ventricular tachycardia cardiac arrest
Critical Care, 2011Co-Authors: Miljenko Križmaric, Stefek GrmecAbstract:Partial pressure of end-tidal carbon dioxide (PetCO2) during cardiopulmonary resuscitation (CPR) correlates with cardiac output and consequently has a prognostic value in CPR. In our previous study we confirmed that initial PetCO2 value was significantly higher in Asphyxial arrest than in ventricular fibrillation/pulseless ventricular tachycardia (VF/VT) cardiac arrest. In this study we sought to evaluate the pattern of PetCO2 changes in cardiac arrest caused by VF/VT and Asphyxial cardiac arrest in patients who were resuscitated according to new 2005 guidelines. The study included two cohorts of patients: cardiac arrest due to Asphyxia with initial rhythm asystole or pulseless electrical activity (PEA), and cardiac arrest due to arrhythmia with initial rhythm VF or pulseless VT. PetCO2 was measured for both groups immediately after intubation and repeatedly every minute, both for patients with or without return of spontaneous circulation (ROSC). We compared the dynamic pattern of PetCO2 between groups. Between June 2006 and June 2009 resuscitation was attempted in 325 patients and in this study we included 51 patients with Asphyxial cardiac arrest and 63 patients with VF/VT cardiac arrest. The initial values of PetCO2 were significantly higher in the group with Asphyxial cardiac arrest (6.74 ± 4.22 kilopascals (kPa) versus 4.51 ± 2.47 kPa; P = 0.004). In the group with Asphyxial cardiac arrest, the initial values of PetCO2 did not show a significant difference when we compared patients with and without ROSC (6.96 ± 3.63 kPa versus 5.77 ± 4.64 kPa; P = 0.313). We confirmed significantly higher initial PetCO2 values for those with ROSC in the group with primary cardiac arrest (4.62 ± 2.46 kPa versus 3.29 ± 1.76 kPa; P = 0.041). A significant difference in PetCO2 values for those with and without ROSC was achieved after five minutes of CPR in both groups. In all patients with ROSC the initial PetCO2 was again higher than 1.33 kPa. The dynamic pattern of PetCO2 values during out-of-hospital CPR showed higher values of PetCO2 in the first two minutes of CPR in Asphyxia, and a prognostic value of initial PetCO2 only in primary VF/VT cardiac arrest. A prognostic value of PetCO2 for ROSC was achieved after the fifth minute of CPR in both groups and remained present until final values. This difference seems to be a useful criterion in pre-hospital diagnostic procedures and attendance of cardiac arrest.
Katja Lah - One of the best experts on this subject based on the ideXlab platform.
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Difference in end-tidal CO_2 between Asphyxia cardiac arrest and ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest in the prehospital setting
Critical Care, 2003Co-Authors: Stefek Grmec, Katja Lah, Ksenija Tušek-buncAbstract:Introduction There has been increased interest in the use of capnometry in recent years. During cardiopulmonary resuscitation (CPR), the partial pressure of end-tidal carbon dioxide (PetCO_2) correlates with cardiac output and, consequently, it has a prognostic value in CPR. This study was undertaken to compare the initial PetCO_2 and the PetCO_2 after 1 min during CPR in Asphyxial cardiac arrest versus primary cardiac arrest. Methods The prospective observational study included two groups of patients: cardiac arrest due to Asphyxia with initial rhythm asystole or pulseless electrical activity, and cardiac arrest due to acute myocardial infarction or malignant arrhythmias with initial rhythm ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The PetCO_2 was measured for both groups immediately after intubation and then repeatedly every minute, both for patients with and without return of spontaneous circulation (ROSC). Results We analyzed 44 patients with Asphyxial cardiac arrest and 141 patients with primary cardiac arrest. The first group showed no significant difference in the initial value of the PetCO_2, even when we compared those with and without ROSC. There was a significant difference in the PetCO_2 after 1 min of CPR between those patients with ROSC and those without ROSC. The mean value for all patients was significantly higher in the group with Asphyxial arrest. In the group with VF/VT arrest there was a significant difference in the initial PetCO_2 between patients without and with ROSC. In all patients with ROSC the initial PetCO_2 was higher than 10 mmHg. Conclusions The initial PetCO_2 is significantly higher in Asphyxial arrest than in VT/VF cardiac arrest. Regarding Asphyxial arrest there is also no difference in values of initial PetCO_2 between patients with and without ROSC. On the contrary, there is a significant difference in values of the initial PetCO_2 in the VF/VT cardiac arrest between patients with and without ROSC. This difference could prove to be useful as one of the methods in prehospital diagnostic procedures and attendance of cardiac arrest. For this reason we should always include other clinical and laboratory tests.
