Risultati per: Circulation

Circulation, Volume 148, Issue Suppl_1, Page A315-A315, November 6, 2023. Introduction:Non-traumatic cardiac arrest (NTCA) is associated with low survival and substantial societal cost. Standard-of-care treatments, such as cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS), have limitations in restoring cardiac function and improving outcomes. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an adjunct to CPR for NTCA. However, the optimal patient population that will benefit most from REBOA remains uncertain.Goals:This translational study investigated the impact of varying low-flow duration (15- vs 30-mins) on REBOA’s hemodynamic performance and ability to achieve return of spontaneous circulation (ROSC) in a swine model of NTCA.Methods:Thirty-two swine were anesthetized and placed into ventricular fibrillation. All animals received a 4-min “no-flow” period before mechanical CPR was initiated. Animals were randomized into four groups to receive: 1) 15- vs 30-minutes of CPR; 2) REBOA vs. no-REBOA (control). After completion of the 15- or 30-minute low-flow period, ACLS was initiated and REBOA was fully-inflated in experimental animals.Results:There were no differences in demographics or hemodynamics at baseline (T = -10-mins) or at randomization (T = +10-mins). In the 15-mins groups, there were no differences in the rates of ROSC between REBOA (4 / 8, 50%) and control (4 / 8, 50%; p = 0.99). However, in the 30-min group the REBOA animals had a significantly higher rate of ROSC (6 / 8, 75%) compared to control (1 / 8, 12.5%; p = 0.04). In the 7-mins (T = 34 – 41 mins) after REBOA deployment in the 30-min animals there was a statistically significant difference in diastolic blood pressure (repeated measures ANOVA; p = 0.027). Importantly, 5 / 6 (83%) animals that received ROSC in the 30-min group with REBOA re-arrested at least once with 3 / 6 (50%) maintaining ROSC until study completion.Conclusion:In our swine model of NTCA, REBOA preferentially improved hemodynamics and ROSC after a 30-mins period of low-flow CPR, compared to 15-mins of low-flow CPR. REBOA may be a viable strategy to improve ROSC after prolonged downtime. More hemodynamic support will be required to maintain ROSC. This has implications for patient selection in upcoming human trials of REBOA in NTCA.

Circulation, Volume 148, Issue Suppl_1, Page A136-A136, November 6, 2023. Introduction:High value of end-tidal carbon dioxide (EtCO2), measured at the end of a tracheal tube, is closely associated with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) resuscitation. The aim of this study was to evaluate whether EtCO2 measured at the face mask (FM) before an intubation procedure, may also predict ROSC in OHCA.Material and Methods:This was a prospective non-interventional study. Between May 1st2022 and January 30th2023, all patients ≥ 18 years with an OHCA on EMS arrival and for whom a laryngoscopy for tracheal intubation was considered, were included. An EtCO2 sensor was directly placed between the valve of the bag-valve-mask and the FM while cardiopulmonary resuscitation was continued. Age, gender, initial rhythm, ROSC on scene and last EtCO2 at the FM (FM-EtCO2) value before laryngoscopy were collected. Patients were assigned to 3 groups: FM-EtCO2 < 10 mmHg ; 10 mmHg

Circulation, Volume 148, Issue Suppl_1, Page A210-A210, November 6, 2023. Background:Free fatty acids (FFA) are a known risk factor in the development of sudden cardiac death. However, the relationship between FFA and the outcome of out-of-hospital cardiac arrest (OHCA) patients remains unclear. We aimed to examine the association between FFA and neurological outcomes in OHCA patients.Methods:This prospective observational study included adult (≥ 18 years) OHCA patients between February 2016 and December 2022. We measured serial FFA levels within 1 h after ROSC and at 6 h, 12 h, 24 h, 48 h, and 72 h after the return of spontaneous circulation (ROSC). The primary outcome was neurological outcome at 6 months. A poor neurological outcome was defined by cerebral performance categories 3, 4, and 5.Results:A total of 147 patients were included. Of them, 104 (70.7%) had poor neurological outcomes, whereby the median FFA levels within 1 h after ROSC (0.72 vs. 1.01 mol/L), at 6 h (1.19 vs. 1.90 mol/L), 12 h (1.20 vs. 1.66 mol/L), and 24 h (1.20 vs. 1.95 mol/L) after ROSC were significantly lower than in good outcome group. The FFA levels at 6 h (odds ratio [OR], 0.583; 95% confidence interval [CI], 0.370-0.919; P = 0.020), and 12 h (OR, 0.509; 95% CI, 0.303-0.854; P = 0.011) after ROSC were independently associated with poor neurological outcomes.Conclusions:The lower FFA levels at 6 h and 12 h after ROSC were associated with poor neurological outcomes in patients with OHCA. FFA may reflect oxidative metabolism as well as oxidative stress.

Circulation, Volume 148, Issue Suppl_1, Page A17366-A17366, November 6, 2023. Introduction:The presence of a restrictive atrial septum in the setting of transposition of the great arteries (TGA) is associated with a high risk of hypoxic ischemic injury upon transition to postnatal circulation. Fetal cardiovascular magnetic resonance (CMR) measures of vessel flow and oxygen saturation provide a unique opportunity to study fetal TGA hemodynamics at baseline and during acute maternal hyperoxygenation.Methods:Thirty-one pregnant mothers with fetuses diagnosed with TGA and an intact ventricular septum (n=23) or small ventricular septal defect (n=8) were recruited and underwent fetal CMR in room air and during administration of 10L/min of oxygen by face mask for up to 45 minutes. Blood flow and oxygen saturations were measured in the major fetal vessels using cine phase contrast MRI and MR relaxometry at baseline and during hyperoxygenation.Results:Two patients exhibited severe restriction at the atrial septum, one undergoing fetal atrial septostomy at 37 weeks and one requiring cannulation onto ECMO shortly after birth. Both revealed reversal of the usual relationship of oxygen saturation between the aorta and the main pulmonary artery at baseline and during hyperoxygenation, i.e. in TGA with restrictive atrial septum the saturations are higher in the aorta than pulmonary. Acute maternal supplemental oxygen was associated with increased pulmonary blood flow (p=0.008) and reduced foramen ovale (p=0.01) and ductus arteriosus shunting (p=0.01). There were no significant changes in umbilical vein, descending aorta and superior vena cava flow. Fetal oxygen saturations increased throughout fetal circulation (p

Circulation, Volume 148, Issue 16, Page 1254-1258, October 17, 2023.

Circulation, Volume 148, Issue 10, Page 848-851, September 5, 2023.

Stroke, Ahead of Print. BACKGROUND:Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with National Institutes of Health Stroke Scale score of 0 to 5 is common in clinical practice but has not yet been proven safe and effective. Our objective is to assess whether EVT on top of best medical treatment (BMT) in AIS patients with large-vessel occlusion of the anterior circulation presenting with mild symptoms is beneficial compared with BMT.METHODS:We searched MEDLINE, SCOPUS, and reference lists of retrieved articles published until December 28, 2022. A systematic literature search was conducted to identify clinical trials or observational cohort studies evaluating patients with AIS due to anterior circulation large-vessel occlusion and admission National Institutes of Health Stroke Scale score ≤5 treated with EVT versus BMT alone. The primary outcome was excellent functional outcome (modified Rankin Scale score 0–1) at 3 months. The protocol had been registered before data collection (PROSPERO).RESULTS:Eleven observational eligible studies were included in the meta-analysis, comprising a total of 2019 AIS patients with National Institutes of Health Stroke Scale score ≤5 treated with EVT versus 3171 patients treated with BMT. EVT was not associated with excellent functional outcome (risk ratio, 1.10 [95% CI, 0.93–1.31]). When stratified for different study design (per-protocol versus intention-to-treat), there were no significant subgroup differences. EVT was not associated with good functional outcome (modified Rankin Scale score 0–2; risk ratio, 1.01 [95% CI, 0.89–1.16]) or reduced disability at 3 months (common odds ratio, 0.92 [95% CI, 0.60–1.41]). Symptomatic intracranial hemorrhage was more common in the patients receiving EVT (risk ratio, 3.53 [95% CI, 2.35–5.31]). No correlation was found between EVT and mortality at 3 months (risk ratio, 1.34 [95% CI, 0.83–2.18]). The same overall associations were confirmed in the sensitivity analysis of studies that performed propensity score matching.CONCLUSIONS:EVT appears equivalent to BMT for patients with anterior circulation large-vessel occlusion AIS with low baseline National Institutes of Health Stroke Scale, despite the increased risk for symptomatic intracranial hemorrhage.Registration:URL:https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022334417.

Circulation, Volume 148, Issue 5, Page 430-435, August 1, 2023.

Circulation, Volume 148, Issue 2, Page 162-166, July 11, 2023.

Circulation, Volume 148, Issue 1, Page 1-3, July 4, 2023.

Circulation, Volume 147, Issue 22, Page 1705-1710, May 30, 2023.

Circulation, Volume 147, Issue 17, Page 1304-1308, April 25, 2023.

Circulation, Volume 147, Issue 15, Page 1183-1185, April 11, 2023.

Circulation, Volume 147, Issue 13, Page 1039-1044, March 28, 2023.

Circulation, Volume 147, Issue 12, Page 977-981, March 21, 2023.

Stroke, Volume 54, Issue 3, Page 743-750, March 1, 2023. Background:The benefit of distinguishing between disabling versus nondisabling deficit in mild acute ischemic stroke due to endovascular thrombectomy-targetable vessel occlusion (EVT-tVO; including anterior circulation large and medium-vessel occlusion) is unknown. We compared safety and efficacy of acute reperfusion treatments in disabling versus nondisabling mild EVT-tVO.Methods:From the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register, we included consecutive acute ischemic stroke patients (2015–2021) treated within 4.5 hours, with full NIHSS items availability and score ≤5, evidence of intracranial internal carotid artery, M1, A1-2, or M2-3 occlusion. After propensity score matching, we compared efficacy (3-month modified Rankin Scale score of 0–1, modified Rankin Scale score of 0–2, and early neurological improvement) and safety (nonhemorrhagic early neurological deterioration, any intracerebral or subarachnoid hemorrhage, symptomatic intracranial hemorrhage, and death at 3-month) outcomes in disabling versus nondisabling patients—adopting an available definition.Results:We included 1459 patients. Propensity score matched analysis of disabling versus nondisabling EVT-tVO (n=336 per group) found no significant differences in efficacy (modified Rankin Scale score 0–1: 67.4% versus 71.5%,P=0.336; modified Rankin Scale score 0–2: 77.1% versus 77.6%,P=0.895; early neurological improvement: 38.3% versus 44.4%,P=0.132) and safety (nonhemorrhagic early neurological deterioration: 8.5% versus 8.0%,P=0.830; any intracerebral hemorrhage or subarachnoid hemorrhage: 12.5% versus 13.3%,P=0.792; symptomatic intracranial hemorrhage: 2.6% versus 3.4%,P=0.598; and 3-month death: 9.8% versus 9.2%,P=0.844) outcomes.Conclusions:We found similar safety and efficacy outcomes after acute reperfusion treatment in disabling versus nondisabling mild EVT-tVO; our findings suggest to adopt similar acute treatment approaches in the 2 groups. Randomized data are needed to clarify the best reperfusion treatment in mild EVT-tVO.