Journal of electrocardiology
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Comparative Study
Predicting defibrillation success in sudden cardiac arrest patients.
Although the importance of quality cardiopulmonary resuscitation (CPR) and its link to survival is still emphasized, there has been recent debate about the balance between CPR and defibrillation, particularly for long response times. Defibrillation shocks for ventricular fibrillation (VF) of recently perfused hearts have high success for the return of spontaneous circulation (ROSC), but hearts with depleted adenosine triphosphate (ATP) stores have low recovery rates. Since quality CPR has been shown to both slow the degradation process and restore cardiac viability, a measurement of patient condition to optimize the timing of defibrillation shocks may improve outcomes compared to time-based protocols. ⋯ For Sp = 90%, the Se range was 33-45%; for Se = 90%, the Sp range was 49-63%. The features showed good shock-success prediction performance. We believe that a defibrillator employing a clinical decision tool based on these features has the potential to improve overall survival from cardiac arrest.
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Early reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) is essential. Although primary percutaneous coronary intervention (pPCI) is the preferred revascularization technique, it often involves longer primary transportation or secondary inter-hospital transfers and thus longer system related delays. The current ESC Guidelines state that PCI should be performed within 120 minutes from first medical contact, and door-to-balloon time should be <60 minutes in order to reduce long term mortality. ⋯ Based on data from more than 100 patients transferred over the past decade, we have found a similar in-hospital and long term mortality rate compared to the main island inhabitants. In conclusion, with the optimal collaboration within a STEMI network including local hospitals, university clinics, EMS and military helicopters using the same telemedicine system and field triage of STEMI patients, most patients can be treated within the time limits suggested by the current guidelines. These organizational changes are likely to contribute to the improved mortality rate for STEMI patients.
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An asymptomatic woman with no clinical history consulted for pneumonia-induced fever; she then presented episodes of syncope due to polymorphic ventricular tachycardia and ECG alterations compatible with Brugada syndrome. Genetic studies showed no alterations in the SCN5A gene but other polymorphisms were observed. Further genetic studies are required to elucidate the pathophysiological mechanisms of fever and the function of sodium channels.
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To improve patient outcome, point-of-care (POC) cardiac troponin I/T (cTn I/T) tests applied in a prehospital setting and/or emergency department might play a role as a substitute for central hospital laboratory high-sensitivity (hs) cTn I/T testing if their analytical and clinical performance are equivalent to central hospital laboratory hs cTn I/T tests and if they fulfill an unmet clinical need in the diagnostic work-up of patients with acute coronary syndrome (ACS). To date, current point-of-care (POC) cTn I/T tests are not yet sufficiently analytically sensitive and do not provide accurate and precise values in the reference range nor at the 99th percentile of a healthy reference population. ⋯ Although patients with acute ST-segment elevation myocardial infarction (STEMI) are generally diagnosed by ischemic symptoms and ECG only, hospitalized patients with non-STEMI and unstable angina pectoris (UAP) should preferentially be tested with ECG and central hospital laboratory hs cTn I/T tests unless the ECG has already demonstrated diagnostic changes. More evidence and future trials are needed to find out whether in patients with NSTE ACS hs cTn I/T tests should be combined with other tests, such as a test of B-type natriuretic peptide or NT-proBNP.