Rev Cardiovasc Med
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Cardiocerebral resuscitation is a new approach to patients with primary cardiac arrest that has been shown to dramatically increase survival. The term cardiocerebral is used to stress that the issue is immediate and effective support of the central circulation. Cardiocerebral resuscitation consists of continuous chest compressions--without mouth-to-mouth ventilations--administered by bystanders, and a new algorithm for emergency medical services that consists of sets of 200 chest compressions before and immediately after electrocardiographic analysis and, if indicated, a single shock. ⋯ Early establishment of intravenous or intraosseous access for epinephrine is emphasized. Postresuscitation care for comatose patients includes early coronary intervention and 24 hours of mild hypothermia. Studies show marked improvement in prehospital cardiac arrest patients with return of spontaneous circulation who subsequently received specialized postresuscitation care.
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Patients with drug-eluting stents appear to be at increased risk of thrombosis beyond 30 days (late) or even 1 year (very late) after stent placement. Patients with recent placement of drug-eluting stents who are receiving dual-antiplatelet therapy pose a challenge in the perioperative period. ⋯ There are currently no universal recommendations for decreasing the risk of stent thrombosis. We herein outline a strategy involving the use of glycoprotein IIb/IIIa inhibitors as "bridging therapy" during the high-risk perioperative period and report on 8 patients who successfully underwent bridging therapy with no adverse cardiac outcomes (death, myocardial infarction, or stent thrombosis) or bleeding complications.
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A mainstay of therapy for congestive heart failure has been the use of potent diuretic agents, such as furosemide, that target the kidney to enhance sodium and water excretion. Although furosemide is widely used to treat the symptoms of acute decompensated heart failure (ADHF), the consequent activation of the renin-angiotensin-aldosterone system may limit the natriuretic response by reducing the glomerular filtration rate. ⋯ In order to preserve and/or enhance renal function in ADHF, especially with agents such as conventional diuretics and vasodilators, an understanding of intrarenal factors that may protect the kidney may provide a direction for optimal use of current therapies and also lead to newer therapeutic strategies. Vasodilators, especially those that are linked to cGMP activation, may provide an alternative approach.