2023 ESC Guidelines for the management of acute coronary syndromes

European Heart Journal, Journal Year: 2023, Volume and Issue: 44(38), P. 3720 - 3826

Published: Aug. 25, 2023

Language: Английский

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Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis

Intensive Care Medicine, Journal Year: 2021, Volume and Issue: 47(12), P. 1393 - 1414

Published: Oct. 27, 2021

Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, main cause mortality long-term disability. This review describes mechanisms PCABI, its treatment options, outcomes, suggested strategies for outcome prediction.

Language: Английский

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2023 ESC Guidelines for the management of acute coronary syndromes

European Heart Journal Acute Cardiovascular Care, Journal Year: 2023, Volume and Issue: 13(1), P. 55 - 161

Published: Sept. 22, 2023

Journal Article Corrected proof Guidelines 2023 ESC for the management of acute coronary syndromes: Developed by task force on syndromes European Society Cardiology (ESC) Get access Robert A Byrne, Byrne (Ireland) Corresponding authors: A. Department and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Ireland, School Pharmacy Biomolecular Sciences, RCSI University Medicine Health Ireland. Tel: +353-1-2483190, E-mail: [email protected] https://orcid.org/0000-0001-5224-6393 Search other works this author on: Oxford Academic Google Scholar Xavier Rossello, Rossello (Spain) https://orcid.org/0000-0001-6783-8463 J Coughlan, Coughlan https://orcid.org/0000-0001-6086-3279 Emanuele Barbato, Barbato (Italy) https://orcid.org/0000-0002-0050-5178 Colin Berry, Berry (United Kingdom) https://orcid.org/0000-0002-4547-8636 Alaide Chieffo, Chieffo https://orcid.org/0000-0002-3505-9112 Marc Claeys, Claeys (Belgium) https://orcid.org/0000-0002-6628-9543 Gheorghe-Andrei Dan, Dan (Romania) https://orcid.org/0000-0001-9867-2582 R Dweck, Dweck https://orcid.org/0000-0001-9847-5917 Mary Galbraith, Galbraith https://orcid.org/0000-0002-4196-1815 ... Show more Martine Gilard, Gilard (France) Lynne Hinterbuchner, Hinterbuchner (Austria) https://orcid.org/0000-0001-5369-7399 Ewa Jankowska, Jankowska (Poland) https://orcid.org/0000-0002-9202-432X Peter Jüni, Jüni Takeshi Kimura, Kimura (Japan) Vijay Kunadian, Kunadian https://orcid.org/0000-0003-2975-6971 Margret Leosdottir, Leosdottir (Sweden) https://orcid.org/0000-0003-1677-1566 Roberto Lorusso, Lorusso (Netherlands) https://orcid.org/0000-0002-1777-2045 F E Pedretti, Pedretti https://orcid.org/0000-0003-1789-8657 Angelos G Rigopoulos, Rigopoulos (Greece) https://orcid.org/0000-0003-0735-2319 Maria Rubini Gimenez, Gimenez (Germany) https://orcid.org/0000-0003-2384-8250 Holger Thiele, Thiele Pascal Vranckx, Vranckx Sven Wassmann, Wassmann Nanette Kass Wenger, Wenger States America) Borja Ibanez, Ibanez Clinical Department, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain, IIS-Fundación Jiménez Díaz Hospital, CIBERCV, ISCIII, Spain. +3491 4531200, [email protected] https://orcid.org/0000-0002-5036-254X Scientific Document Group Heart Journal. Acute Care, zuad107, https://doi.org/10.1093/ehjacc/zuad107 Published: 22 September history typeset:

Language: Английский

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Oxygen Targets in Comatose Survivors of Cardiac Arrest

New England Journal of Medicine, Journal Year: 2022, Volume and Issue: 387(16), P. 1467 - 1476

Published: Aug. 27, 2022

The appropriate oxygenation target for mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown.In this randomized trial with a 2-by-2 factorial design, we randomly assigned adults 1:1 ratio to either restrictive oxygen partial pressure arterial (Pao2) 9 10 kPa (68 75 mm Hg) or liberal Pao2 13 14 (98 105 Hg); patients were also one two blood-pressure targets (reported separately). primary outcome was composite death from any cause hospital discharge severe disability coma (Cerebral Performance Category [CPC] 3 4; categories range 1 5, higher values indicating more disability), whichever occurred first within 90 days after randomization. Secondary outcomes neuron-specific enolase levels at 48 hours, cause, the score on Montreal Cognitive Assessment (ranging 0 30, scores better cognitive ability), modified Rankin scale 6, greater and CPC days.A total 789 underwent A primary-outcome event 126 394 (32.0%) restrictive-target group 134 395 (33.9%) liberal-target (hazard ratio, 0.95; 95% confidence interval, 0.75 1.21; P = 0.69). At days, had 113 (28.7%) 123 (31.1%) group. On CPC, median category groups; scale, 2 group; Assessment, 27 groups. level 17 μg per liter 18 incidence adverse events similar groups.Targeting strategy resuscitation resulted coma. (Funded by Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).

Language: Английский

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ERC-ESICM guidelines on temperature control after cardiac arrest in adults

Intensive Care Medicine, Journal Year: 2022, Volume and Issue: 48(3), P. 261 - 269

Published: Jan. 28, 2022

Language: Английский

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Prediction of good neurological outcome in comatose survivors of cardiac arrest: a systematic review

Intensive Care Medicine, Journal Year: 2022, Volume and Issue: 48(4), P. 389 - 413

Published: March 4, 2022

To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, moderate disability (CPC 1–2 mRS 0–3) at discharge intensive care unit later, in comatose adult survivors cardiac arrest (CA). PubMed, EMBASE, Web Science and Cochrane Database Systematic Reviews were searched. Sensitivity specificity for outcome calculated each predictor. The risk bias was using QUIPS tool. A total 37 studies included. Due heterogeneities recording times, predictor thresholds, definition some predictors, meta-analysis not performed. withdrawal localisation motor response pain immediately 72–96 h after ROSC, normal values neuron-specific enolase (NSE) 24 h-72 a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 µV continuous background without discharges on electroencephalogram (EEG) 72 absent diffusion restriction cortex deep grey matter MRI 2–7 ROSC predicted with more than 80% sensitivity above 40% most studies. Most had high bias. In survivors, clinical, biomarker, electrophysiology, imaging identified patients destined first week

Language: Английский

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Neurofilaments as biomarkers in neurological disorders — towards clinical application

Nature Reviews Neurology, Journal Year: 2024, Volume and Issue: 20(5), P. 269 - 287

Published: April 12, 2024

Language: Английский

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Effect of Lower vs Higher Oxygen Saturation Targets on Survival to Hospital Discharge Among Patients Resuscitated After Out-of-Hospital Cardiac Arrest

JAMA, Journal Year: 2022, Volume and Issue: 328(18), P. 1818 - 1818

Published: Oct. 26, 2022

The administration of a high fraction oxygen following return spontaneous circulation in out-of-hospital cardiac arrest may increase reperfusion brain injury.To determine whether targeting lower saturation the early phase postresuscitation care for improves survival at hospital discharge.This multicenter, parallel-group, randomized clinical trial included unconscious adults with and peripheral (Spo2) least 95% while receiving 100% oxygen. was conducted 2 emergency medical services 15 hospitals Victoria South Australia, between December 11, 2017, August 2020, data collection from ambulance records (final follow-up date, 25, 2021). enrolled 428 planned 1416 patients.Patients were by paramedics to receive titration achieve an either 90% 94% (intervention; n = 216) or 98% (standard care; 212) until arrival intensive unit.The primary outcome discharge. There 9 secondary outcomes collected, including hypoxic episodes (Spo2 <90%) prespecified serious adverse events, which hypoxia rearrest.The stopped due COVID-19 pandemic. Of patients who randomized, 425 analysis (median age, 65.5 years; 100 [23.5%] women) all completed trial. Overall, 82 214 (38.3%) intervention group survived discharge compared 101 211 (47.9%) standard (difference, -9.6% [95% CI, -18.9% -0.2%]; unadjusted odds ratio, 0.68 0.46-1.00]; P .05). collected during stay, 8 showed no significant difference. A episode prior observed 31.3% (n 67) participants 16.1% 34) 15.2% 7.2%-23.1%]; OR, 2.37 1.49-3.79]; < .001).Among achieving after arrest, 94%, 100%, admission unit did not significantly improve Although is limited termination pandemic, findings do support use target setting resuscitation arrest.ClinicalTrials.gov Identifier: NCT03138005.

Language: Английский

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Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest

New England Journal of Medicine, Journal Year: 2023, Volume and Issue: 389(1), P. 45 - 57

Published: June 15, 2023

Guidelines recommend normocapnia for adults with coma who are resuscitated after out-of-hospital cardiac arrest. However, mild hypercapnia increases cerebral blood flow and may improve neurologic outcomes.We randomly assigned had been arrest of presumed or unknown cause admitted to the intensive care unit (ICU) in a 1:1 ratio either 24 hours (target partial pressure arterial carbon dioxide [Paco2], 50 55 mm Hg) Paco2, 35 45 Hg). The primary outcome was favorable outcome, defined as score 5 (indicating lower moderate disability) higher, assessed use Glasgow Outcome Scale-Extended (range, 1 [death] 8, higher scores indicating better outcome) at 6 months. Secondary outcomes included death within months.A total 1700 patients from 63 ICUs 17 countries were recruited, 847 targeted 853 normocapnia. A months occurred 332 764 (43.5%) group 350 784 (44.6%) (relative risk, 0.98; 95% confidence interval [CI], 0.87 1.11; P = 0.76). Death randomization 393 816 (48.2%) 382 832 (45.9%) 1.05; CI, 0.94 1.16). incidence adverse events did not differ significantly between groups.In arrest, lead than (Funded by National Health Medical Research Council Australia others; TAME ClinicalTrials.gov number, NCT03114033.).

Language: Английский

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The spectrum of sepsis-associated encephalopathy: a clinical perspective

Critical Care, Journal Year: 2023, Volume and Issue: 27(1)

Published: Oct. 5, 2023

Abstract Sepsis-associated encephalopathy is a severe neurologic syndrome characterized by diffuse dysfunction of the brain caused sepsis. This review provides concise overview diagnostic tools and management strategies for SAE at acute phase in long term. Early recognition diagnosis are crucial effective management. Because evaluation can be confounded several factors intensive care unit setting, multimodal approach warranted Diagnostic commonly employed include clinical evaluation, metabolic tests, electroencephalography, neuroimaging selected cases. The usefulness blood biomarkers injury remains limited. Clinical involves assessing patient's mental status, motor responses, brainstem reflexes, presence abnormal movements. Electroencephalography rule out non-convulsive seizures help detect patterns various severity such as generalized slowing, epileptiform discharges, triphasic waves. In patients with encephalopathy, value non-contrast computed tomography septic persistent seizures, and/or focal signs, magnetic resonance imaging detects more than 50% cases, mainly cerebrovascular complications, white matter changes. Timely identification treatment underlying infection paramount, along control systemic that may contribute to secondary injury. Upon admission ICU, maintaining appropriate levels oxygenation, pressure, balance crucial. Throughout ICU stay, it important mindful potential neurotoxic effects associated specific medications like midazolam cefepime, closely monitor seizures. efficacy targeted neurocritical during optimizing patient outcomes deserves further investigated. lead permanent sequelae. Seizures occurring increase susceptibility long-term epilepsy. Extended stays sepsis-associated linked functional disability neuropsychological sequelae, underscoring necessity surveillance comprehensive patients.

Language: Английский

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