Time to positivity as a novel predictor of outcome in intensive care unit patients with sepsis
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INTRODUCTION. Cardiac Arrest (CA) is an important cause of death, 50 percent occurring outside hospitals. One-half of these patients are found in Ventricular Fibrillation (VF) or pulseless ventricular taquicardia. Within this group, better survival is achieved with early defibrillation (less than four to eight minutes). Early BLS is also associated with better survival, by delaying the deterioration of the cardiac rhythm to asystole. METHODS. Case report.RESULTS. We describe the case of a 80 years old man, who suffered CA shortly after arrival to his local health department, for an appointment with his GP. Several weeks before he began to suffer from typical effort angina and that day he was feeling unwell. Basic Life Support (BLS) was started promptly and an Advance Life Support (ALS) team was requested through the national emergency number. Nine minutes after, ALS team arrived and confirmed CA, with VF. The victim was defibrillated with a 200 J shock and BLS resumed. When orotracheal intubation was attempted, masseter muscle contraction was noticed, so BLS was discontinued for reevaluation. The rhythm had become a wide QRS tachycardia with pulse and the victim recovered spontaneous breathing. Partial consciousness was recovered (Glasgow Coma Score: 11). On physical examination blood pressure was 133/62 mmHg, heart rate 130 bpm and pulse oximetry 97%. The patient was transferred to an emergency department. Half an hour later, as he recovered consciousness fully, he complained of chest pain. The ECG showed a sinus rhythm with a heart rate of 75, right bundle branch block and ST segment depression in in leads V4 to V6. Laboratorial tests showed cardiac troponine I 0.78 ng/ml. A coronary angiography performed urgently, disclosed significant left main plus three vessel -coronary artery disease. Left anterior descending artery (LAD) was occluded, with late retrograde flow. Eighteen hours after the CA, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the proximal LAD. Post-operative course was uneventful and the patient was discharged on day 7 after the procedure. Sixteen months later, he remains asymptomatic.CONCLUSION. This case illustrates the possibility of a happy end after an episode of sudden CA, in an old patient with undiagnosed severe coronary artery disease and presumable acute coronary syndrome. Although ALS was started nine minutes after the witnessed collapse, return of spontaneous circulation after the first defibrillation and prompt breathing recovery contributed to the success of the resuscitation maneuvers. The fact that CA occurred in a health care facility allowed prompt BLS, which contributed to the recovery. Furthermore, the speed in the detection and treatment of the acute reversible cause (myocardial ischemia in this case) was crucial for long-term prognosis. INTRODUCTION. Hyperglycemia has suppressive effects on immune function and an associated increased risk of infection, endothelial damage and development of tissue isch...
INTRODUCTION. Cardiac Arrest (CA) is an important cause of death, 50 percent occurring outside hospitals. One-half of these patients are found in Ventricular Fibrillation (VF) or pulseless ventricular taquicardia. Within this group, better survival is achieved with early defibrillation (less than four to eight minutes). Early BLS is also associated with better survival, by delaying the deterioration of the cardiac rhythm to asystole. METHODS. Case report.RESULTS. We describe the case of a 80 years old man, who suffered CA shortly after arrival to his local health department, for an appointment with his GP. Several weeks before he began to suffer from typical effort angina and that day he was feeling unwell. Basic Life Support (BLS) was started promptly and an Advance Life Support (ALS) team was requested through the national emergency number. Nine minutes after, ALS team arrived and confirmed CA, with VF. The victim was defibrillated with a 200 J shock and BLS resumed. When orotracheal intubation was attempted, masseter muscle contraction was noticed, so BLS was discontinued for reevaluation. The rhythm had become a wide QRS tachycardia with pulse and the victim recovered spontaneous breathing. Partial consciousness was recovered (Glasgow Coma Score: 11). On physical examination blood pressure was 133/62 mmHg, heart rate 130 bpm and pulse oximetry 97%. The patient was transferred to an emergency department. Half an hour later, as he recovered consciousness fully, he complained of chest pain. The ECG showed a sinus rhythm with a heart rate of 75, right bundle branch block and ST segment depression in in leads V4 to V6. Laboratorial tests showed cardiac troponine I 0.78 ng/ml. A coronary angiography performed urgently, disclosed significant left main plus three vessel -coronary artery disease. Left anterior descending artery (LAD) was occluded, with late retrograde flow. Eighteen hours after the CA, a quadruple coronary artery bypass grafting operation was undertaken. During surgery, a fresh thrombus was removed from the proximal LAD. Post-operative course was uneventful and the patient was discharged on day 7 after the procedure. Sixteen months later, he remains asymptomatic.CONCLUSION. This case illustrates the possibility of a happy end after an episode of sudden CA, in an old patient with undiagnosed severe coronary artery disease and presumable acute coronary syndrome. Although ALS was started nine minutes after the witnessed collapse, return of spontaneous circulation after the first defibrillation and prompt breathing recovery contributed to the success of the resuscitation maneuvers. The fact that CA occurred in a health care facility allowed prompt BLS, which contributed to the recovery. Furthermore, the speed in the detection and treatment of the acute reversible cause (myocardial ischemia in this case) was crucial for long-term prognosis. INTRODUCTION. Hyperglycemia has suppressive effects on immune function and an associated increased risk of infection, endothelial damage and development of tissue isch...
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