Tag Archives: cardiac arrest

Confounding elements in the recognition of severe hyperkalemia. A case report

Rareș Sebastian Ciumbrudean, Șerban Ellias Trella, Andra Tichindeleanu, Ioan Topor

Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

DOI: 10.2478/amma-2024-0036

Introduction: Severe hyperkalemia is a life-threatening condition that demands a rapid diagnosis and prompt treatment. The following case report highlights the possible complexity in the clinical presentation of this condition and the importance of a thorough assessment of patients that do not provide the classical clinical findings.
Case presentation: A 40-year-old male called the emergency services for low blood pressure and an overall altered state. Upon arrival, the prehospital team found a patient with shock signs that was complaining of feeling unwell and reported profuse diarrhea starting three days prior. Additionally, the patient also had muscle weakness and occasional spastic movements of the limbs and face. During the assessment, the patient went suddenly into cardiac arrest, life support (including the management of hyperkalemia) was immediately started and return of spontaneous circulation was soon obtained. Point-of-care blood testing established the diagnosis of severe hyperkalemia. Definitive in-hospital care consisted mainly of fluid resuscitation, circulatory support, hemodialysis and antimicrobial therapy and the patient was discharged 16 days later with no neurological impairment.
Conclusions: Although atypical, hyperkalemia can be caused by diarrhea in certain circumstances and its clinical manifestations can be misleading. Thus, keeping a broad clinical perspective and early use of blood tests can ensure proper treatment of life-threatening hyperkalemia.

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Metabolic Markers Evolution During Antegrade and Retrograde Normothermic Blood Cardioplegia

Raicea V1, Moraru L1, Raicea I2, Șerban V1, Péter Orsolya1, Raicea Camelia3, Gusu Rodiana4

1 University of Medicine and Pharmacy, Clinic of Cardiovascular Surgery, Tîrgu Mureș, Romania
2 University of Texas Medical School of Houston, Department of Cardiothoracic and Vascular Surgery, Houston, USA
3 Institute of Public Health Tîrgu Mureș, Romania
4 University of Medicine and Pharmacy, Faculty of Medicine, Tîrgu Mureș, Romania

Background: Several studies suggested that the ventricular myocardium is suboptimally protected during retrograde blood cardioplegia.
Methods: Twenty patients (10 patients for subgrups) undergoing an elective valvular replacement mitral and aortic, with right atrial approach, mitral transeptal or tricupid procedures were randomized to receive antegrade or retrograde normothermic blood oxigenated cardioplegia. Astrup determinations (astrup values, lactate production, pH and BE) and ventricular differences in oxygen extraction from separate coronary ostium canulation were monitored during aortic cross-clamping at time at cardioplegic delevery immediately after cross clamping, at first, 20 minutes or 30 minutes of ischemia, after aortic declamping immediately and after 10 minutes. Hemodynamic recovery and postoperative complications were noted.
Results: The preoperative characteristics of the two groups were similar. Lactate production and oxygen extraction in the right ventricular myocardium were higher in the retrograde group. In this group, the right ventricle also extracted more oxygen and produced more lactate and acid than did the left ventricle. A typical cumulative ischemic pattern with progressively decreasing pH, BE values and progressively increasing lactate values could be observed similar in both groups in all patients. It was not the degree of lactate washout, but the lactate concentration at the end of each reperfusion wich increased proportional with ischemic time bettewen cardioplegic administration and after declamping — that correlated significantly with global metabolic recovery time. Nevertheless, the postoperative course was uneventful in both groups.
Conclusions: Despite of value of lactate production, acidosis and oxygen extraction, were more prominent in the right ventricular myocardium during retrograde cardioplegia after declampation, at 10 minutes this value became similar, and clinical and inotropic necesity were similar in this two groups. During antegrade cardioplegia the washout of myocardial metabolites is very efficient and the peak levels of lactate decrease rapidly at the end of cardioplegic administration and after declampation compared with retrograde administration. No diference seems to be seen between retrograde or anterograde cardioplegic administration 10 minutes after declampation. Nevertheless the postoperative course seems to be unproblematic in two series.

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Study on the Pre-hospital Cardiac Arrest Resuscitations Of the Mobile Intensive Care Ambulance Teams From Tîrgu Mureș, Romania, in 2009

Copotoiu Sanda-Maria1, Bratu Simona2

1 Department of Anesthesiology and Intensive Care, Clinical Emergency County Hospital, Tîrgu Mureş, Romania
2 UPU-SMURD, Clinical Emergency County Hospital, Tîrgu-Mureş, Romania

Objective: To analyze the results of the resuscitation efforts of the SMURD medical teams, in pre-hospital, in 2009.
Methods: We conducted a prospective study between 01/01/2009 – 12/31/2009. We included in the study all the cases with cardiac arrest at the arrival, those that occurred during transport and all the CPR attempts performed together with the first aid teams. For the statistical study we used SPSS program version 17, χ2 test and p values were determined to compare the data obtained.
Results: In 2009, the team had 250 cardiac arrest cases, 16.7% of the total of 1490 calls. Resuscitation was performed on 67.6% of patients.The good outcome of the resuscitation was statistically correlated with the distance to the case p = 0.01.The acute coronary syndrome was responsible for 27% of the cardiac arrest cases, severe trauma for 11%. The initial cardiac arrest rhythm was in 83.2% of cases asystole. BLS was performed, before the arrival of the team, to a number of 41 patients, bystander CPR representing only 2.36%. The SMURD team resuscitated a number of 58 patients in pre-hospital, 34.32% out of the 169 that had CPR, 41 died in the Emergency Department and 17 were hospitalized; 4 patients were discharged in good condition.
Conclusions: The early resuscitation outcome is good, comparable with the international data reported, the rate of late survival is smaller. The proportion of ventricular rhythms with a good prognosis is lower, which correlates with longer distances traveled to the scene and less involvement of the population in BLS.

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Study on the Activity of the Cardiac Arrest Teams from the Emergency Department of the Clinical Emergency County Hospital from Tîrgu Mureș, Romania, in 2009

Bratu Simona1, Copotoiu Sanda-Maria2

1 UPU-SMURD, Clinical Emergency County Hospital, Tîrgu-Mureş, Romania
2 Department of Anesthesiology and Intensive Care, Clinical Emergency County Hospital, Tîrgu Mureş, Romania

Objective: To evaluate the activity of the Cardiac Arrest Team (CAT) from the Emergency Department, called to perform resuscitation for patients admitted in different departments of the Clinical County Hospital.
Methods: We conducted a prospective study between 01/01–12/31/2009. We included all the patients we performed CPR on, regardless of indication.
Results: We had a total of 110 cases, representing 0.28% of the 39,074 patients assisted by the department in 2009. We noticed an increased incidence of calls in internal medicine and surgery departments, with 50% and 17% of the cases respectively. The most frequent diagnosis was cardiac arrest for respiratory failure and malignant tumors, each representing 17%, even though malignancy does not have an indication for resuscitation. There was no causal relationship between the outcome of resuscitation and age groups (p = 0.552), type of wards (p = 0.36), or the Basic Life Support (BLS) performed by the staff, before the CAT arrived (p = 0.76). Medical staff from wards started BLS in 40.1% of cases, in 32% of these cases only chest compressions were performed, without ventilation.The proportion of resuscitated versus deceased cases is 49.1% to 50.9%, so immediate results are good, unfortunately the late outcome is bad, 52 cases out of the 54 died later in ICU, 2 patients being discharged in good condition.
Conclusions: CAT should be called according to Do Not resuscitate criteria. Medical staff from the wards should be trained to start CPR and have basic equipment. The early outcome is comparable with the international data, the poor late results binds to resuscitation without indication.

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Study on the Resuscitations Performed in the Emergency Department of the Clinical Emergency County Hospital from Târgu Mureș in 2009

Bratu Simona¹, Copotoiu Sanda-Maria2,3

1 UPU-SMURD, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Anesthesia and Intensive Care, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Objectives: The study assesses the results of the cardiac arrest resuscitations performed by the medical staff of the Emergency Department of The Clinical Emergency County Hospital from Târgu-Mureş in the year 2009.
Method: We conducted a prospective study between 01.01-31.12.2009, including the cardiac arrest cases occurred in the ED or brought with ongoing resuscitation from the pre-hospital setting. For the statistical study we used SPSS program, version 17; the χ2 tests and p values were determined to compare the data.
Results: We had a total of 186 cases of cardiac arrest, representing 0.47% of the total 39.074 patients assisted in the ED in 2009. The gender distribution of the cases showed a higher incidence in male (61%) and the most affected age groups ranged between 60–80 years. The patients with cardiac arrests presented various diagnosis: the highest incidence is acute coronary syndrome 32 patients (17%), followed by sepsis/MSOF 20 (11%), pneumonia/asthma 17 (9%), pulmonary embolism 17 (9%), stroke 13 (7%), etc. We have resuscitated successfully 42 patients, representing 22.58 % of the total 186 cases. All 42 patients were transferred to the hospitals departments. Out of the hospitalized patients, 25 died later on the wards and 17 (40.47%) survived and were discharged home, 6 from the Intensive Care Department and 11 from the Coronary Unit.
Conclusions: The results are comparable with the reported international data. The cases with cardiac arrest due to acute coronary syndrome, ventricular rhythms and those witnessed and treated early in the ED are having a better outcome.

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