The Early Change in PaCO2 After Extracorporeal Membrane Oxygenation Initiation is Associated with Neurological Complications.

The Early Change in PaCO2 After Extracorporeal Membrane Oxygenation Initiation is Associated with Neurological Complications. Am J Respir Crit Care Med. 2020 Apr 06;: Authors: Cavayas YA, Munshi L, Del Sorbo L, Fan E Abstract RATIONALE: Large decreases in PaCO2 that occur when initiating extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure may cause cerebral vasoconstriction and compromise brain tissue perfusion. OBJECTIVES: To determine if the magnitude of PaCO2 correction upon ECMO initiation is associated with an increased incidence of neurological complications in patients with respiratory failure. METHODS: We conducted a multicenter international retrospective cohort study using the Extracorporeal Life Support Organization (ELSO) Registry, including adults with respiratory failure on any ECMO mode between 2012 and 2017. The relative change in PaCO2 in the first 24 hours was calculated as (24hPostECMOPaCO2 - PreECMOPaCO2)/PreECMOPaCO2. Our primary outcome was the occurrence of neurological complications, defined as seizures, ischemic stroke, intracranial hemorrhage, or brain death. MEASUREMENTS AND MAIN RESULTS: We included 11,972 patients, 88% of whom were supported with venovenous-ECMO. The median relative change in PaCO2 was -31% (IQR -46 to -12%). Neurological complications were uncommon overall (6.9%) with a low incidence of seizures (1.1%), ischemic stroke (1.9%), intracranial hemorrhage (3.5%), and bra...
Source: American Journal of Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Am J Respir Crit Care Med Source Type: research

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Conclusion: Compared to pCT, DECT within 36 h after IV thrombolysis for acute ischemic stroke, changes the radiological diagnosis of post-treatment ICH to “CS only” in a small proportion of patients. Studies are warranted of whether the altered radiological reports have an impact on patient management, for example initiation timing of antithrombotic secondary prevention.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Objective: To evaluate clinical and radiological outcomes after revascularization of hemorrhagic moyamoya disease (MMD).Materials and Methods: We retrospectively collected patients with hemorrhagic MMD who received revascularization from January 2011 to June 2018 at a high-volume stroke center. Rebleeding, ischemic stroke, modified Rankin Scale (mRS) and death after revascularization were used to evaluate long-term clinical outcome. Poor neurological outcome was defined as a mRS>2. The changes of original and revascularization collaterals were used to evaluate radiological outcome. The clinical and radiological outcomes...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
AbstractThe role of hyperosmolar therapy (HT) in large hemispheric ischemic or hemorrhagic strokes remains a controversial issue. Past and current stroke guidelines state that it represents a reasonable therapeutic measure for patients with either neurological deterioration or intracranial pressure (ICP) elevations documented by ICP monitoring. However, the lack of evidence for a clear effect of this therapy on radiological tissue shifts and clinical outcomes produces uncertainty with respect to the appropriateness of its implementation and duration in the context of radiological mass effect without clinical correlates of ...
Source: Neurocritical Care - Category: Neurology Source Type: research
Objective: To explore the value of whole-brain perfusion parameters combined with multiphase computed tomography angiography (MP-CTA) in predicting the hemorrhagic transformation (HT) of ischemic stroke. Methods: A total of 64 patients with ischemic stroke who underwent noncontrast computed tomography, computed tomography perfusion imaging, and computed tomography angiography before treatment from August 2017 to June 2019 were included retrospectively. The perfusion parameters cerebral blood volume (CBV), cerebral blood flow (CBF), time to peak (TTP), mean transit time (MTT), time to maximum (Tmax), and permeability surfac...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
ConclusionOur everyday clinical practice experience suggests 9.8  % of consecutive AIS patients present in the 4.5–9 h window and 2.2 % adhere to EXTEND neuroimaging eligibility criteria for IVT. Only 1.3% of AIS is eligible for IVT according to EXTEND neuroimaging and clinical eligibility criteria.
Source: Neuroradiology - Category: Radiology Source Type: research
Conclusions: There is no justification for the use of reperfusion procedures in acute ischaemic stroke in the anterior circulation in patients with initially unfavourable multimodal computed tomography scores. PMID: 31908703 [PubMed]
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
Conclusions: At least 27 pediatric neurocritical care centers use transcranial Doppler during clinical care. In the majority of centers, studies are performed and interpreted by credentialed personnel, and findings are used to guide clinical management. Further studies are needed to standardize these practices.
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Neurocritical Care Source Type: research
ConclusionsA portable gamma-camera could be a useful and feasible tool for the diagnosis of BD.ResumenObjetivoEvaluar la factibilidad del empleo de la minigammacámara portátil Sentinella®, para el diagnóstico de muerte encefálica (ME).DiseñoEstudio observacional, prospectivo, de factibilidad.ÁmbitoUnidad de cuidados intensivos de un hospital de tercer nivel.PacientesDesde enero a diciembre de 2017 se registraron de forma consecutiva los pacientes mayores de edad que tras su ingreso en unidad de cuidados intensivos fueron diagnosticados de ME según criterios clínic...
Source: Medicina Intensiva - Category: Intensive Care Source Type: research
Written by Meyers, edits by SmithA 50-ish year old man was working construction when he suddenly collapsed. Coworkers started CPR within 1 minute of collapse. EMS arrived within 10 minutes and continued CPR and ACLS, noting alternating asystole and sinus bradycardia during rhythm checks. He received various ACLS medications and arrived at the ED with a perfusing rhythm.Initial vitals included heart rate around 100 bpm and BP 174/96. Here is his initial ECG, very soon after ROSC:What do you think?Sinus tachycardia.  There is incomplete RBBB (QRS duration less than 120 ms).  There is diffuse STD, maximal in V4-V5 a...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Publication date: Available online 16 October 2019Source: Epilepsy &BehaviorAuthor(s): Giada Pauletto, Francesco Bax, Gian Luigi Gigli, Simone Lorenzut, Lorenzo Verriello, Elisa Corazza, Mariarosaria ValenteAbstractAim of the studyThe aim of the study was to evaluate the clinical characteristics of patients with previous stroke (either ischemic or hemorrhagic), who developed status epilepticus (SE) mimicking a stroke relapse.Materials and methodsWe performed a retrospective cohort study of patients brought to hospital by the emergency service between December 2016 and January 2018 with a stroke code as possible candida...
Source: Epilepsy and Behavior - Category: Neurology Source Type: research
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