Tag Archives: Cardiovascular

Effects of Epinephrine on Cerebral Oxygenation during CPR

Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation during CPR has not been documented in the clinical setting. Therefore, Deakin et al examined the effect of epinephrine on cerebral brain oxygenation during in-hospital cardiac arrest.

They found that 1 mg intravenous epinephrine, administered during advanced life support resuscitation, was not associated with a clinically significant change in cerebral tissue oxygenation.

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Cellular Mechanisms of Prevention of Ischemia-Reperfusion Injury

Ischemic preconditioning is the phenomenon whereby brief periods of sublethal ischemia protect against a subsequent, more prolonged, ischemic insult. In remote ischemic preconditioning, ischemia to one organ protects other organs at a distance. Olenchock et al created mouse models to ask if inhibition of the alpha-ketoglutarate-dependent dioxygenase Egln1, which senses oxygen and regulates the hypoxia-inducible factor transcription factor, could suffice to mediate local and remote ischemic preconditioning.

Using somatic gene deletion and a pharmacological inhibitor, they found that inhibiting Egln1 systemically or in skeletal muscles protects mice against myocardial ischemia-reperfusion injury.

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Free, Online CE Activities on Acute Decompensated Heart Failure

Obtain free continuing education credits by viewing the educational content from the Society of Critical Care Medicine’s (SCCM) 2016 Congress session, Tailoring Therapy and Improving Outcomes in Patients with Acute Decompensated Heart Failure (ADHF), supported by an educational grant from Novartis Pharmaceuticals Corporation. Available in two formats, you can choose from the webcast version, Tailoring Therapy & Improving Outcomes in Patients with ADHF, or the electronic publication, Acute Decompensated Heart Failure Monograph.

Both versions contain discussions from experts Ileana L. Piña, MD, MPH, of Montefiore Einstein Center for Heart and Vascular Care, Javed Butler, MD, MPH, FACC, FAHA, MBA, of Stony Brook University, and Peter S. Pang, MD, MS, FACEP, FACC, FAHA, of Indiana University School of Medicine. Topics include the diagnosis and classification of ADHF, existing therapies, new guidelines and safety and efficacy data for new and emerging treatment therapies, as well as strategies for individualizing therapy to improve patient outcomes. Physicians, nurses, and pharmacists are eligible to receive continuing education credits.

Other Online CME Available
Whether you missed SCCM’s 2016 Critical Care Congress or couldn’t make it to all the sessions of interest, you can still participate in the most popular sessions online at your convenience. Earn free continuing medical education (CME) credits by viewing any of the following webcasts and then applying for credit:

Every Patient Has a Story: Individualizing the Management of Invasive Fungal Infections in the Critical Care Setting
Supported by an educational grant from Astellas Pharma Global Development, Inc.

Improving Clinical Outcomes and Pathogen-Directed Therapy for Serious Bacterial Infections in the Critical Care Setting
Supported by an educational grant from Merck & Co., Inc.

Optimizing Treatment and Improving Care Transitions in Chronic Heart Failure
Supported by an educational grant from Amgen

The Role of Biomarkers in Acute Kidney Injury Assessment
Supported by an educational grant from Astute Medical, Inc.

Rate Control vs. Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Atrial fibrillation continues to plague intensivists managing post-cardiac surgery patients. Large clinical trials in non-surgical populations have demonstrated that rhythm control offers no benefits over a simpler rate control strategy. However, it is unclear if these findings can be extrapolated to the post-cardiac surgical population. As such, Gillinov et al conducted a randomized controlled trial hoping to answer this very question.

They found that strategies for rate control and rhythm control to treat post-operative atrial fibrillation were associated with equal numbers of days of hospitalization, similar complication rates and similarly low rates of persistent atrial fibrillation 60 days after onset.

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Examining the Efficacy of L-citrulline Supplementation

Chronic lung disease in neonates and infants can lead to progressive hypoxia-induced pulmonary hypertension. The development of pulmonary hypertension has been associated with increasing mortality in certain infants, and the therapies available are inadequate. Fike et al set out to determine whether starting L-citrulline (in newborn piglets) after the onset of pulmonary hypertension inhibits disease progression and improves nitric oxide production by recoupling endothelial nitric oxide synthase.

The authors found that oral L-citrulline treatment started after disease onset improves nitric oxide production by recoupling endothelial nitric oxide synthase and inhibits the further development of chronic hypoxia-induced pulmonary hypertension in this piglet model. This is an important translational study with novel treatment implications. Some clinical studies have already been done using prophylactic L-citrulline supplementation. However, more work using the supplement after the physiologic insult has occurred are clearly needed, and this study provides a strong background for further investigation.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Diastolic Dysfunction in Children with Fluid Refractory Septic Shock

The presence of cardiac dysfunction in patients with septic shock has been described for decades. However, the true prevalence or ultimate effect of diastolic dysfunction has only been described in septic children in limited fashion. Sankar et al analyzed 56 children (all between three months and 17 years of age) with fluid refractory septic shock, before inotropes or mechanical ventilation were initiated. The primary objectives of this study were to determine the prevalence of diastolic dysfunction in children with fluid refractory septic shock and to determine if there was an association between diastolic dysfunction and mortality.

The authors demonstrated that diastolic dysfunction in children with fluid refractory septic shock is relatively common, similar to some adult findings. Interestingly, children with diastolic dysfunction and those with no cardiac dysfunction had higher mortality rates than those with systolic dysfunction (43%, 37% and 15%, respectively), though these differences were not statistically significant. In the wake of this study, questions still linger about the true prevalence of diastolic dysfunction in children with fluid refractory septic shock. Further studies are needed to confirm these findings.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.

Does Colchicine Prevent Atrial Fibrillation and PPS After Cardiac Surgery?

Due to its ability to actively disrupt microtubules, attenuate neutrophil activation and reduce inflammation, oral colchicine is a potentially promising agent for reducing morbidity after cardiac surgery. Imazio and investigators from the COPPS-2 (Colchicine for Prevention of the Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation) study group attempted to determine the efficacy and safety of colchicine to reduce postpericardiotomy syndrome (PPS), postoperative atrial fibrillation (AF) and postoperative pericardial/pleural effusion. The subjects in the study were patients undergoing cardiac surgery drawn from 11 Italian centers.

Colchicine was found to reduce the incidence of PPS, but did not reduce postoperative AF or postoperative pericardial/pleural effusion. However, the ability to generalize these results is limited due to the nature of the selected patient population.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.