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Peter Paal - One of the best experts on this subject based on the ideXlab platform.
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problems and pitfalls of qualification for extracorporeal rewarming in severe accidental Hypothermia
Journal of Cardiothoracic and Vascular Anesthesia, 2016Co-Authors: Anna Jarosz, Peter Paal, Sylweriusz Kosinski, Tomasz Darocha, Robert Galązkowski, Hubert Hymczak, Rafal DrwilaAbstract:Objectives When establishing the Severe Hypothermia Treatment Centre, certain problems and pitfalls regarding the qualification for extracorporeal rewarming were encountered. The authors shared their experience and opened a discussion with other centers that deal with severe, accidental Hypothermia. Design Retrospective analysis of medical records of all patients examined by the Hypothermia coordinator. Setting Patients consulted and treated by the Severe Hypothermia Treatment Centre. Participants Patients who underwent accidental Hypothermia. Interventions From July 2013 until January 2016, Hypothermia coordinators at the Severe Hypothermia Treatment Centre examined the cases of 152 hypothermic patients. Of those cases, 127 patients were subjected to noninvasive rewarming in referral hospitals and 25 were accepted to the center for extracorporeal rewarming. Measurements and Main Results Difficulties that deferred or delayed the implementation of extracorporeal membrane oxygen rewarming were identified and addressed, including low platelet/red blood count, intraperitoneal fluid of unknown origin, abnormal results of head computed tomography, extremes of age, bleeding from the external auditory meatus, inaccuracy of infrared-based thermometers, iatrogenic trauma to the femoral vessels, chronic/terminal comorbidities, poisonings, pregnancy, hypoglycemia, hemodynamic stability despite severe Hypothermia, and decontamination protocol. Conclusions The problems discussed may delay the use of extracorporeal membrane oxygen rewarming in hypothermic patients but should not discourage medical teams from the implementation of extracorporeal rewarming. The prognosis for severe Hypothermia is favorable, even with a long resuscitation time and low core temperatures.
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Accidental Hypothermia–an update
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2016Co-Authors: Peter Paal, Les Gordon, Monika Brodmann Maeder, Gabriel Putzer, Beat Walpoth, Michael Wanscher, Giacomo Strapazzon, Doug Brown, Michael Holzer, Gregor BroessnerAbstract:BackgroundThis paper provides an up-to-date review of the management and outcome of accidental Hypothermia patients with and without cardiac arrest.MethodsThe authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review.ResultsThe hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary Hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature
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accidental Hypothermia an update the content of this review is endorsed by the international commission for mountain emergency medicine icar medcom
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2016Co-Authors: Les Gordon, Gabriel Putzer, Beat Walpoth, Giacomo Strapazzon, Peter Paal, Monika Brodmann Maeder, Michael WanscherAbstract:This paper provides an up-to-date review of the management and outcome of accidental Hypothermia patients with and without cardiac arrest. The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary Hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care. Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental Hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.
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delayed and intermittent cpr for severe accidental Hypothermia
Resuscitation, 2015Co-Authors: Les Gordon, Peter Paal, John Ellerton, Hermann Brugger, Giles J Peek, Ken ZafrenAbstract:Abstract Introduction Cardiac arrest (CA) in patients with severe accidental Hypothermia (core temperature Methods A literature search was performed. The authors used the findings to develop guidelines. Results Full neurological recovery is possible even with prolonged CA if the brain was already severely hypothermic before CA occurred. Data from surgery during deep hypothermic CA and prehospital case reports underline the feasibility of delayed and intermittent CPR in patients who have arrested due to severe Hypothermia. Conclusions Continuous CPR is recommended for CA due to primary severe Hypothermia. Mechanical chest-compression devices should be used when available and CPR-interruptions avoided. Only if this is not possible should CPR be delayed or performed intermittently. Based on the available data, a patient with a core temperature
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Akzidentelle Hypothermie
Wiener klinisches Magazin, 2014Co-Authors: Anne Schmidt, Gabriel Putzer, Hermann Brugger, Peter PaalAbstract:Advances in the efficiency and availability of rewarming techniques have improved the prognosis for patients presenting with Hypothermia. For hypothermic patients with a core body temperature ≥ 28 °C without cardiac instability there is increasing evidence to support the use of active external and minimally invasive rewarming techniques (e.g., chemical, electrical or forced air heating packs and blankets, warm parenteral fluids). Hypothermic patients with cardiac instability (systolic blood pressure
Wulf Paschen - One of the best experts on this subject based on the ideXlab platform.
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moderate Hypothermia induces marked increase in levels and nuclear accumulation of sumo2 3 conjugated proteins in neurons
Journal of Neurochemistry, 2012Co-Authors: Liangli Wang, Burkhard G Mackensen, Wei Yang, Wulf PaschenAbstract:Deep Hypothermia protects the brain from ischemic damage and is therefore used during major cardiovascular surgeries requiring cardiopulmonary bypass and a period of circulatory arrest. Here, we demonstrated that small ubiquitin-like modifier (SUMO1-3) conjugation is markedly activated in the brain during deep to moderate Hypothermia. Animals were subjected to normothermic (37°C) or deep to moderate (18°C, 24°C, 30°C) hypothermic cardiopulmonary bypass, and the effects of Hypothermia on SUMO conjugation were evaluated by Western blot and immunohistochemistry. Exposure to moderate 30°C Hypothermia was sufficient to markedly increase levels and nuclear accumulation of SUMO2/3-conjugated proteins in these cells. Deep Hypothermia induced nuclear translocation of the SUMO-conjugating enzyme Ubc9, suggesting that the increase in nuclear levels of SUMO2/3-conjugated proteins observed in brains of hypothermic animals is an active process. Exposure of primary neuronal cultures to deep Hypothermia induced only a moderate rise in levels of SUMO2/3-conjugated proteins. This suggests that neurons in vivo have a higher capacity than neurons in vitro to activate this endogenous potentially neuroprotective pathway upon exposure to Hypothermia. Identifying proteins that are SUMO2/3 conjugated during Hypothermia could help to design new strategies for preventive and therapeutic interventions to make neurons more resistant to a transient interruption of blood supply.
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Moderate Hypothermia induces marked increase in levels and nuclear accumulation of SUMO2/3‐conjugated proteins in neurons
Journal of Neurochemistry, 2012Co-Authors: Liangli Wang, Wei Yang, Qing Ma, G. Burkhard Mackensen, Wulf PaschenAbstract:Deep Hypothermia protects the brain from ischemic damage and is therefore used during major cardiovascular surgeries requiring cardiopulmonary bypass and a period of circulatory arrest. Here, we demonstrated that small ubiquitin-like modifier (SUMO1-3) conjugation is markedly activated in the brain during deep to moderate Hypothermia. Animals were subjected to normothermic (37°C) or deep to moderate (18°C, 24°C, 30°C) hypothermic cardiopulmonary bypass, and the effects of Hypothermia on SUMO conjugation were evaluated by Western blot and immunohistochemistry. Exposure to moderate 30°C Hypothermia was sufficient to markedly increase levels and nuclear accumulation of SUMO2/3-conjugated proteins in these cells. Deep Hypothermia induced nuclear translocation of the SUMO-conjugating enzyme Ubc9, suggesting that the increase in nuclear levels of SUMO2/3-conjugated proteins observed in brains of hypothermic animals is an active process. Exposure of primary neuronal cultures to deep Hypothermia induced only a moderate rise in levels of SUMO2/3-conjugated proteins. This suggests that neurons in vivo have a higher capacity than neurons in vitro to activate this endogenous potentially neuroprotective pathway upon exposure to Hypothermia. Identifying proteins that are SUMO2/3 conjugated during Hypothermia could help to design new strategies for preventive and therapeutic interventions to make neurons more resistant to a transient interruption of blood supply.
Liangli Wang - One of the best experts on this subject based on the ideXlab platform.
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moderate Hypothermia induces marked increase in levels and nuclear accumulation of sumo2 3 conjugated proteins in neurons
Journal of Neurochemistry, 2012Co-Authors: Liangli Wang, Burkhard G Mackensen, Wei Yang, Wulf PaschenAbstract:Deep Hypothermia protects the brain from ischemic damage and is therefore used during major cardiovascular surgeries requiring cardiopulmonary bypass and a period of circulatory arrest. Here, we demonstrated that small ubiquitin-like modifier (SUMO1-3) conjugation is markedly activated in the brain during deep to moderate Hypothermia. Animals were subjected to normothermic (37°C) or deep to moderate (18°C, 24°C, 30°C) hypothermic cardiopulmonary bypass, and the effects of Hypothermia on SUMO conjugation were evaluated by Western blot and immunohistochemistry. Exposure to moderate 30°C Hypothermia was sufficient to markedly increase levels and nuclear accumulation of SUMO2/3-conjugated proteins in these cells. Deep Hypothermia induced nuclear translocation of the SUMO-conjugating enzyme Ubc9, suggesting that the increase in nuclear levels of SUMO2/3-conjugated proteins observed in brains of hypothermic animals is an active process. Exposure of primary neuronal cultures to deep Hypothermia induced only a moderate rise in levels of SUMO2/3-conjugated proteins. This suggests that neurons in vivo have a higher capacity than neurons in vitro to activate this endogenous potentially neuroprotective pathway upon exposure to Hypothermia. Identifying proteins that are SUMO2/3 conjugated during Hypothermia could help to design new strategies for preventive and therapeutic interventions to make neurons more resistant to a transient interruption of blood supply.
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Moderate Hypothermia induces marked increase in levels and nuclear accumulation of SUMO2/3‐conjugated proteins in neurons
Journal of Neurochemistry, 2012Co-Authors: Liangli Wang, Wei Yang, Qing Ma, G. Burkhard Mackensen, Wulf PaschenAbstract:Deep Hypothermia protects the brain from ischemic damage and is therefore used during major cardiovascular surgeries requiring cardiopulmonary bypass and a period of circulatory arrest. Here, we demonstrated that small ubiquitin-like modifier (SUMO1-3) conjugation is markedly activated in the brain during deep to moderate Hypothermia. Animals were subjected to normothermic (37°C) or deep to moderate (18°C, 24°C, 30°C) hypothermic cardiopulmonary bypass, and the effects of Hypothermia on SUMO conjugation were evaluated by Western blot and immunohistochemistry. Exposure to moderate 30°C Hypothermia was sufficient to markedly increase levels and nuclear accumulation of SUMO2/3-conjugated proteins in these cells. Deep Hypothermia induced nuclear translocation of the SUMO-conjugating enzyme Ubc9, suggesting that the increase in nuclear levels of SUMO2/3-conjugated proteins observed in brains of hypothermic animals is an active process. Exposure of primary neuronal cultures to deep Hypothermia induced only a moderate rise in levels of SUMO2/3-conjugated proteins. This suggests that neurons in vivo have a higher capacity than neurons in vitro to activate this endogenous potentially neuroprotective pathway upon exposure to Hypothermia. Identifying proteins that are SUMO2/3 conjugated during Hypothermia could help to design new strategies for preventive and therapeutic interventions to make neurons more resistant to a transient interruption of blood supply.
Les Gordon - One of the best experts on this subject based on the ideXlab platform.
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Accidental Hypothermia–an update
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2016Co-Authors: Peter Paal, Les Gordon, Monika Brodmann Maeder, Gabriel Putzer, Beat Walpoth, Michael Wanscher, Giacomo Strapazzon, Doug Brown, Michael Holzer, Gregor BroessnerAbstract:BackgroundThis paper provides an up-to-date review of the management and outcome of accidental Hypothermia patients with and without cardiac arrest.MethodsThe authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review.ResultsThe hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary Hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature
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accidental Hypothermia an update the content of this review is endorsed by the international commission for mountain emergency medicine icar medcom
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2016Co-Authors: Les Gordon, Gabriel Putzer, Beat Walpoth, Giacomo Strapazzon, Peter Paal, Monika Brodmann Maeder, Michael WanscherAbstract:This paper provides an up-to-date review of the management and outcome of accidental Hypothermia patients with and without cardiac arrest. The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary Hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients. Extracorporeal life support (ECLS) has revolutionised the management of hypothermic cardiac arrest, with survival rates approaching 100 % in some cases. Hypothermic patients with risk factors for imminent cardiac arrest (temperature <28 °C, ventricular arrhythmia, systolic blood pressure <90 mmHg), and those who have already arrested, should be transferred directly to an ECLS-centre. Cardiac arrest patients should receive continuous cardiopulmonary resuscitation (CPR) during transfer. If prolonged transport is required or terrain is difficult, mechanical CPR can be helpful. Delayed or intermittent CPR may be appropriate in hypothermic arrest when continuous CPR is impossible. Modern post-resuscitation care should be implemented following hypothermic arrest. Structured protocols should be in place to optimise pre-hospital triage, transport and treatment as well as in-hospital management, including detailed criteria and protocols for the use of ECLS and post-resuscitation care. Based on new evidence, additional clinical experience and clearer management guidelines and documentation, the treatment of accidental Hypothermia has been refined. ECLS has substantially improved survival and is the treatment of choice in the patient with unstable circulation or cardiac arrest.
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delayed and intermittent cpr for severe accidental Hypothermia
Resuscitation, 2015Co-Authors: Les Gordon, Peter Paal, John Ellerton, Hermann Brugger, Giles J Peek, Ken ZafrenAbstract:Abstract Introduction Cardiac arrest (CA) in patients with severe accidental Hypothermia (core temperature Methods A literature search was performed. The authors used the findings to develop guidelines. Results Full neurological recovery is possible even with prolonged CA if the brain was already severely hypothermic before CA occurred. Data from surgery during deep hypothermic CA and prehospital case reports underline the feasibility of delayed and intermittent CPR in patients who have arrested due to severe Hypothermia. Conclusions Continuous CPR is recommended for CA due to primary severe Hypothermia. Mechanical chest-compression devices should be used when available and CPR-interruptions avoided. Only if this is not possible should CPR be delayed or performed intermittently. Based on the available data, a patient with a core temperature
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severe accidental Hypothermia
BMJ, 2014Co-Authors: Les Gordon, Peter Paal, John Ellerton, Giles J Peek, Julian BarkerAbstract:Few UK emergency departments have a Hypothermia protocol. This must change > “Failure to prepare is preparing to fail” (Benjamin Franklin) Rarely, does a British winter go by without a headline such as “Stranded climber dies from Hypothermia.” Despite the media focus, only about five cases of severe Hypothermia occur each year on British mountains. Hypothermia is more common in urban areas and was an important factor in the deaths of 166 people in the United Kingdom in 2012. In these cases, other factors often included alcohol intoxication, drug overdose, and mental illness. Although cardiopulmonary bypass, and more recently extracorporeal membrane oxygenation (ECMO), have been used in many countries since the late 1960s to rewarm people with hypothermic cardiac arrest,1 2 these techniques have rarely been used for this purpose in the UK.3 In the 1990s, several papers were published on the successful use of cardiopulmonary bypass to rewarm patients with hypothermic cardiac arrest. In 2005, the European Resuscitation Council (ERC) guidelines recognised this technique as the preferred method of active rewarming in hypothermic cardiac arrest. The remarkable survival of a patient from a core temperature of 13.7°C showed what is possible.4 The phrase “not dead until warm and dead” is well known and often quoted …
Wei Yang - One of the best experts on this subject based on the ideXlab platform.
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moderate Hypothermia induces marked increase in levels and nuclear accumulation of sumo2 3 conjugated proteins in neurons
Journal of Neurochemistry, 2012Co-Authors: Liangli Wang, Burkhard G Mackensen, Wei Yang, Wulf PaschenAbstract:Deep Hypothermia protects the brain from ischemic damage and is therefore used during major cardiovascular surgeries requiring cardiopulmonary bypass and a period of circulatory arrest. Here, we demonstrated that small ubiquitin-like modifier (SUMO1-3) conjugation is markedly activated in the brain during deep to moderate Hypothermia. Animals were subjected to normothermic (37°C) or deep to moderate (18°C, 24°C, 30°C) hypothermic cardiopulmonary bypass, and the effects of Hypothermia on SUMO conjugation were evaluated by Western blot and immunohistochemistry. Exposure to moderate 30°C Hypothermia was sufficient to markedly increase levels and nuclear accumulation of SUMO2/3-conjugated proteins in these cells. Deep Hypothermia induced nuclear translocation of the SUMO-conjugating enzyme Ubc9, suggesting that the increase in nuclear levels of SUMO2/3-conjugated proteins observed in brains of hypothermic animals is an active process. Exposure of primary neuronal cultures to deep Hypothermia induced only a moderate rise in levels of SUMO2/3-conjugated proteins. This suggests that neurons in vivo have a higher capacity than neurons in vitro to activate this endogenous potentially neuroprotective pathway upon exposure to Hypothermia. Identifying proteins that are SUMO2/3 conjugated during Hypothermia could help to design new strategies for preventive and therapeutic interventions to make neurons more resistant to a transient interruption of blood supply.
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Moderate Hypothermia induces marked increase in levels and nuclear accumulation of SUMO2/3‐conjugated proteins in neurons
Journal of Neurochemistry, 2012Co-Authors: Liangli Wang, Wei Yang, Qing Ma, G. Burkhard Mackensen, Wulf PaschenAbstract:Deep Hypothermia protects the brain from ischemic damage and is therefore used during major cardiovascular surgeries requiring cardiopulmonary bypass and a period of circulatory arrest. Here, we demonstrated that small ubiquitin-like modifier (SUMO1-3) conjugation is markedly activated in the brain during deep to moderate Hypothermia. Animals were subjected to normothermic (37°C) or deep to moderate (18°C, 24°C, 30°C) hypothermic cardiopulmonary bypass, and the effects of Hypothermia on SUMO conjugation were evaluated by Western blot and immunohistochemistry. Exposure to moderate 30°C Hypothermia was sufficient to markedly increase levels and nuclear accumulation of SUMO2/3-conjugated proteins in these cells. Deep Hypothermia induced nuclear translocation of the SUMO-conjugating enzyme Ubc9, suggesting that the increase in nuclear levels of SUMO2/3-conjugated proteins observed in brains of hypothermic animals is an active process. Exposure of primary neuronal cultures to deep Hypothermia induced only a moderate rise in levels of SUMO2/3-conjugated proteins. This suggests that neurons in vivo have a higher capacity than neurons in vitro to activate this endogenous potentially neuroprotective pathway upon exposure to Hypothermia. Identifying proteins that are SUMO2/3 conjugated during Hypothermia could help to design new strategies for preventive and therapeutic interventions to make neurons more resistant to a transient interruption of blood supply.
