Accuracy of Nasal Nitric Oxide Measurement as a Diagnostic Test for Primary Ciliary Dyskinesia: A Systematic Review and Meta-Analysis

Abstract

a b s t r a c tAim: Extracorporeal resuscitation during cardiopulmonary resuscitation (ECPR) deploys rapid cardiopulmonary bypass to sustain oxygenated circulation until the return of spontaneous circulation (ROSC). The purpose of this systematic review is to address the defining elements and outcomes (quality survival and organ donation) of currently active protocols for ECPR in refractory out-of-hospital cardiac arrest (OHCA) of cardiac origin in adult patients. The results may inform policy and practices for ECPR and help clarify the corrresponding intersection with deceased organ donation. Methods: We searched Medline, Embase, Cochrane and seven other electronic databases from 2005 to 2015, with no language restrictions. Internal validity and the quality of the studies reporting outcomes and guidelines were assessed. The review was included in the international prospective register of systematic reviews (Prospero, CRD42014015259). Results: One guideline and 20 outcome studies were analyzed. Half of the studies were prospective observational studies assessed to be of fair to good methodological quality. The remainder were retrospective cohorts, case series, and case studies. Ages ranged from 16 to 75 years and initial shockable cardiac rhythms, witnessed events, and a reversible primary cause of cardiac arrest were considered favorable prognostic factors. CPR duration and time to hospital cannulation varied considerably. Coronary revascularization, hemodynamic interventions and targeted temperature management neuroprotection were variable. A total of 833 patients receiving this ECPR approach had an overall reported survival rate of Abbreviations: ECPR, extracorporeal resuscitation; ROSC, return of spontaneous circulation; OHCA, out-of-hospital cardiac arrest; CPC, cerebral performance category; GOS, Glasgow Outcome Scale; LOE, level of evidence; ILCOR, International Liaison Committee on Resuscitation; RCTs, randomized controlled trials; TTM, targeted temperature management; IABP, intra-aortic balloon pump; DBD, donation after brain death; cDCD, controlled donation after circulatory determination of death; ELSO, extracorporeal life support organization. I. Ortega-Deballon et al. / Resuscitation 101 (2016) 12-20 13 22%, including 13% with good neurological recovery. Additionally, 88 potential and 17 actual deceased organ donors were identified among the non-survivor population in 8 out of 20 included studies. Study heterogeneity precluded a meta-analysis preventing any meaningful comparison between protocols, interventions and outcomes. Conclusions: ECPR is feasible for refractory OHCA of cardiac origin in adult patients. It may enable neurologically good survival in selected patients, who practically have no other alternative in order to save their lives with quality of life, and contribute to organ donation in those who die. Large, prospective studies are required to clarify patient selection, modifiable outcome variables, risk-benefit and cost-effectiveness.

Primary ciliary dyskinesia (PCD): A genetic disorder of motile cilia

“…Nitric oxide (NO) is a small diffusible gas molecule that is involved in multiple functions throughout the body. Multiple studies have demonstrated that nitric oxide within the nasal cavity (particularly within the sinuses) is high in healthy individuals and much lower (<10% of normal values) in PCD, suggesting that nasal NO (nNO) measurement may be a useful test for PCD [29,84,88,135]. Nasal NO is measured by a non-invasive approach using a small nasal probe to aspirate nasal gas at a rate of approximately 5 ml/second for measurement of nitric oxide content [10,14].…”

Primary Ciliary Dyskinesia in Children

“…ниже) и оцен-ка по предиктивной шкале PICADAR 1 для выявления признаков первичной цилиарной дискинезии у паци-ентов, имеющих хронические респираторные симпто-мы с раннего детского возраста >5 баллов (табл. 1) [7]; • результаты скрининга: исследование уровня оксида азота (NO) в выдыхаемом назальном воздухе (у пода-вляющего большинства пациентов с ПЦД он снижен [8]), при этом до настоящего времени нет единого мне-ния о референсных положительных и отрицательных значениях данного показателя у пациентов с ПЦД. При отсутствии возможности измерения оксида азота в назальном выдыхаемом воздухе допустимо в каче-стве ориентировочного скрининга использовать мето-дики определения оксида азота в выдыхаемом возду-хе, в т.ч.…”

A Rare Case of Kartagener’s Syndrome

“…Epitelyal silyalarda dynein kollarının olmaması elektron mikroskopik incelemede en sık görülen bozukluktur (8). Çocukluk çağında kronik otosinopulmoner enfeksiyon geçirenler hastalarda tarama testi olarak düşük nasal nitrik oksit seviyeleri kullanılsa da tanı koydurucu test olarak elektron mikroskopisi ve genetik testleriyle doğrulanmasına ihtiyaç duymaktadır (9). Hastanın sinüzit, bronşiektazi ve situs inversus triadını sağlamasıyla Kartagener Sendromu tanısı konuldu.…”