Hospital practice (1995)
-
Hospital practice (1995) · Nov 2010
Historical ArticleHistory and current trends in sudden cardiac arrest and resuscitation in adults.
Cardiac arrest occurs when organized cardiac contractility ceases and circulation stops. During cardiac arrest, electrical activity may be abnormal or absent, and the rhythm documented can be ventricular fibrillation, pulseless ventricular tachycardia, pulseless electrical activity, or asystole. It has been estimated that 300 000 sudden cardiac arrests occur each year in the United States, with 75% (225,000) occurring out-of-hospital and 25% (75,000) occurring in-hospital. ⋯ If return of spontaneous circulation occurs during this phase, significant injury to diverse organs may have occurred, producing a critical illness known as post-cardiac arrest syndrome. The post-cardiac arrest syndrome has been recognized as a unique entity requiring unique therapies for successful management. Recent advances in cardiac arrest care include cardiocerebral resuscitation and the use of therapeutic hypothermia to treat comatose survivors of cardiac arrest.
-
Hospital practice (1995) · Nov 2010
Review Meta AnalysisA review and meta-analysis of studies on the effect and timing of β-blocker administration in patients with ST-segment elevation myocardial infarction.
The utility of β-blockers during an evolving ST-segment elevation myocardial infarction (STEMI) has substantial theoretic physiological backing. This coupled with early successes using β-blockers in STEMI promulgated multiple guidelines expanding the use of this class of medication to all patients with acute coronary syndromes. However, recent studies have questioned the utility of β-blockers in the emergency department in these patients. The purpose of this article is to review the evidence behind the use of β-blockers in the emergency department for STEMI patients.
-
Hospital practice (1995) · Nov 2010
Neurologic complications of cardiac surgery and interventional cardiac procedures.
Neurologic complications of cardiac surgery and interventional cardiac procedures may affect the central nervous system or the peripheral nervous system. The most common central nervous system complications are strokes and seizures. This article provides a succinct neuroanatomic and pathophysiologic approach to a wide array of neurologic complications associated with cardiac procedures.
-
Hospital practice (1995) · Nov 2010
Comparative StudyEconomic impact of switching to bivalirudin for a primary percutaneous coronary intervention in a US hospital.
The addition of glycoprotein IIb/IIIa inhibitors (GPIs) to heparin in percutaneous coronary intervention (PCI) procedures has been demonstrated to reduce ischemic complications; however, GPI use is known to increase the risk of bleeding events, which are linked to increased mortality, longer hospital length of stay, greater medical resource utilization, and increased costs. New antithrombotic therapies have the potential to improve clinical outcomes and decrease costs. The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) study of bivalirudin demonstrated significantly reduced clinical event rates (mortality and bleeding) compared with an unfractionated heparin (UFH)+GPI regimen. ⋯ Using a bivalirudin-based strategy in STEMI patients undergoing PPCI is associated with favorable clinical and economic outcomes when compared with an UFH+GPI-based strategy in a US hospital setting.
-
Hospital practice (1995) · Nov 2010
Emerging oral antiplatelet therapies for acute coronary syndromes.
Emergency department physicians, along with hospitalists and interventional cardiologists, provide first-line care for patients experiencing symptoms potentially associated with acute coronary syndromes (ACS). Because these health care providers encounter and manage patients with varying degrees of risk, a clear understanding of the modes of action, benefits, and limitations of various therapeutic options is crucial for achieving optimal outcomes in the acute-care setting. Oral antiplatelet therapy has a major role in the acute care of patients with suspected ACS due to the critical role of platelets in the pathophysiology of disease. ⋯ Ticagrelor has shown a significant ischemic benefit and an increase in non-surgical bleeding over clopidogrel in the large phase 3 Platelet Inhibition and Patient Outcomes trial. Results of phase 2 trials with PAR-1 antagonists suggest that these agents may provide incremental reduction in ischemic events without a bleeding liability. This hypothesis is being evaluated in 2 large ongoing phase 3 trials with vorapaxar, including the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRA*CER) trial in patients with non-ST-segment elevation ACS.