Heart : official journal of the British Cardiac Society
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Editorial Comment Historical Article
The evolving story of "conditioning" to protect against acute myocardial ischaemia-reperfusion injury.
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To investigate whether chronic clinical comorbidity, as collected from emergency medical services (EMS) reports, influences survival after out-of-hospital ventricular fibrillation (VF) cardiac arrest. ⋯ In this cohort, an increasing burden of clinical comorbidity based on a review of EMS reports was associated with a lower odds of survival after VF arrest. This finding suggests that chronic conditions influence arrest pathophysiology and in turn could help guide resuscitation care.
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Ischaemic preconditioning results in a reduction in ischaemic-reperfusion injury to the heart. This beneficial effect is seen both with direct local preconditioning of the myocardium and with remote preconditioning of easily accessible distant non-vital limb tissue. Ischaemic postconditioning with a comparable sequence of brief periods of local ischaemia, when applied immediately after the ischaemic insult, confers benefits similar to preconditioning. ⋯ Remote ischaemic postconditioning is a simple technique to reduce infarct size without the hazards and logistics of multiple coronary artery balloon inflations. This type of conditioning promises clear clinical potential.
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Editorial Comment
Is public access to surgeon-specific data affecting practice adversely?