Intraarrest Rhythms and Rhythm Conversion in Asphyxial Cardiac Arrest

Varvarousi, Giolanda; Chalkias, Athanasios; Stefaniotou, A.; Pliatsika, Paraskevi; Varvarousis, Dimitrios; Koutsovasilis, Anastasios; Xanthos, Theodoros

doi:10.1111/acem.12643

Cited by 9 publications

(5 citation statements)

References 48 publications

(58 reference statements)

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“…VFCA was chosen as a control group. However, a recent experimental study demonstrated that even in ACA there is significant intra-arrest rhythm conversion and that around 70% of the animals exposed to endotracheal clamping at some point during the experiment convert to VF 23 . This experimental study may explain the heterogeneity in the metabolomic profile in some of our animals.…”

Section: Discussionmentioning

confidence: 98%

Metabolomics improves the histopathological diagnosis of asphyxial deaths: an animal proof-of-concept model

Locci

Chighine

Noto

et al. 2021

Sci Rep

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The diagnosis of mechanical asphyxia remains one of the most difficult issues in forensic pathology. Asphyxia ultimately results in cardiac arrest (CA) and, as there are no specific markers, the differential diagnosis of primitive CA and CA secondary to asphyxiation relies on circumstantial details and on the pathologist experience, lacking objective evidence. Histological examination is currently considered the gold standard for CA post-mortem diagnosis. Here we present the comparative results of histopathology versus those previously obtained by 1H nuclear magnetic resonance (NMR) metabolomics in a swine model, originally designed for clinical purposes, exposed to two different CA causes, namely ventricular fibrillation and asphyxia. While heart and brain microscopical analysis could identify the damage induced by CA without providing any additional information on the CA cause, metabolomics allowed the identification of clearly different profiles between the two groups and showed major differences between asphyxiated animals with good and poor outcomes. Minute-by-minute plasma sampling allowed to associate these modifications to the pre-arrest asphyxial phase showing a clear correlation to the cellular effect of mechanical asphyxia reproduced in the experiment. The results suggest that metabolomics provides additional evidence beyond that obtained by histology and immunohistochemistry in the differential diagnosis of CA.

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Section: Discussionmentioning

confidence: 98%

Metabolomics improves the histopathological diagnosis of asphyxial deaths: an animal proof-of-concept model

Locci

Chighine

Noto

et al. 2021

Sci Rep

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“…On the other hand, asphyxial cardiac arrest is characterized by a prolonged time course and an important pre-arrest period where hypoxia and hypercapnia progressively advance along with maintained but gradually deteriorating cardiopulmonary function [ 6 , 32 ]. During the asphyxial interval, general de-energization and mitochondrial complexes inactivation take place in parallel with oxygen shortage, eventually resulting in complete decompensation and a higher degree of energy depletion compared with dysrhythmic cardiac arrest [ 7 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…These indicate a preserved stressed volume and that the endogenous catecholamines seem sufficient for achieving ROSC [ 51 ]. Based on the findings of the present and other studies [ 48 , 50 – 52 ], the inadequacy of global hemodynamic parameters to monitor tissue perfusion and oxygenation [ 53 ], and the significant possibility for spontaneous conversion of a non-shockable rhythm to a shockable one during the asphyxial cardiac arrest interval [ 33 ], the recommendation for administration of adrenaline as soon as possible in asphyxial cardiac arrest with a non-shockable rhythm should be critically re-evaluated, while Pmcf must be further studied as a new prognostic parameter for ROSC regardless of the cause of arrest.…”

Section: Discussionmentioning

confidence: 99%

Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study

Chalkias

Laou

Papagiannakis

et al. 2022

ICMx

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Background Mean circulatory filling pressure (Pmcf) provides information on stressed volume and is crucial for maintaining venous return. This study investigated the Pmcf and other determinants of venous return in dysrhythmic and asphyxial circulatory shock and arrest. Methods Twenty Landrace/Large-White piglets were allocated into two groups of 10 animals each. In the dysrhythmic group, ventricular fibrillation was induced with a 9 V cadmium battery, while in the asphyxia group, cardiac arrest was induced by stopping and disconnecting the ventilator and clamping the tracheal tube at the end of exhalation. Mean circulatory filling pressure was calculated using the equilibrium mean right atrial pressure at 5–7.5 s after the onset of cardiac arrest and then every 10 s until 1 min post-arrest. Successful resuscitation was defined as return of spontaneous circulation (ROSC) with a MAP of at least 60 mmHg for a minimum of 5 min. Results After the onset of asphyxia, a ΔPmca increase of 0.004 mmHg, 0.01 mmHg, and 1.26 mmHg was observed for each mmHg decrease in PaO2, each mmHg increase in PaCO2, and each unit decrease in pH, respectively. Mean Pmcf value in the ventricular fibrillation and asphyxia group was 14.81 ± 0.5 mmHg and 16.04 ± 0.6 mmHg (p < 0.001) and decreased by 0.031 mmHg and 0.013 mmHg (p < 0.001), respectively, for every additional second passing after the onset of cardiac arrest. With the exception of the 5–7.5 s time interval, post-cardiac arrest right atrial pressure was significantly higher in the asphyxia group. Mean circulatory filling pressure at 5 to 7.5 s after cardiac arrest predicted ROSC in both groups, with a cut-off value of 16 mmHg (AUC = 0.905, p < 0.001). Conclusion Mean circulatory filling pressure was higher in hypoxic hypercapnic conditions and decreased at a lower rate after cardiac arrest compared to normoxemic and normocapnic state. A Pmcf cut-off point of 16 mmHg at 5–7.5 s after cardiac arrest can highly predict ROSC.

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“…In OHCA patients with a non-cardiac medical origin with an initial non-shockable rhythm, conversion to shockable rhythm was not associated with good neurologic outcomes. Varvarousi et al reported that the conversion group showed lower ROSC rate than the non-conversion group in an animal asphyxial cardiac arrest study [22].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of the Conversion to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest Patients with Initial Non-Shockable Rhythm

Han

Lee

et al. 2019

JCM

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In patients with out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm, the prognostic significance of conversion to a shockable rhythm (or hereafter “conversion”) during resuscitation remains unclear. We investigated whether conversion is associated with good neurologic outcome. We included patients with OHCA with medical causes and an initial non-shockable rhythm by using the national OHCA surveillance cohort database of the Korea Centers for Disease Control and Prevention for 2012~2016. The primary outcome was good neurologic outcome at hospital discharge. Of 85,602 patients with an initial non-shockable rhythm, 17.9% experienced conversion. Patients with and those without conversion had good neurologic outcome rates of 3.2% and 1.0%, respectively (p < 0.001). In multiple regression analysis, conversion was associated with good neurologic outcome (adjusted odds ratio (OR) 2.604; 95% confidence interval (CI) 2.248–3.015) in the patients with an initial non-shockable rhythm, and had the association with good neurologic outcome (adjusted OR 3.972, 95% CI 3.167–4.983) in unwitnessed patients by emergency medical services (EMS) without pre-hospital return of spontaneous circulation (ROSC) among the population. In patients with OHCA with an initial non-shockable rhythm, even if with unwitnessed arrest by EMS and no pre-hospital ROSC, continuing resuscitation needs to be considered if conversion to a shockable rhythm occurred.

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Intraarrest Rhythms and Rhythm Conversion in Asphyxial Cardiac Arrest

Cited by 9 publications

References 48 publications

Metabolomics improves the histopathological diagnosis of asphyxial deaths: an animal proof-of-concept model

Metabolomics improves the histopathological diagnosis of asphyxial deaths: an animal proof-of-concept model

Determinants of venous return in steady-state physiology and asphyxia-induced circulatory shock and arrest: an experimental study

Prognostic Value of the Conversion to a Shockable Rhythm in Out-of-Hospital Cardiac Arrest Patients with Initial Non-Shockable Rhythm

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