Deployment of a Clinical Pathway to Improve Postcardiac Arrest Care: A Before-After Study*

Objectives: Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. Design: Single-center retrospective before-after study. Setting: Academic PICU. Patients: Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation. Intervention: Deployment of a postcardiac arrest clinical pathway and computerized order entry system. Measurements and Main Results: There were 380 patients included—163 in the pre-pathway period and 217 in the post-pathway period. Primary outcome was percent adherence to pathway clinical goals at 0–6 and 6–24 hours post-return of circulation and to diagnostics (continuous electroencephalogram monitoring, head CT for out-of-hospital cardiac arrests, echocardiogram). Secondary outcomes included survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1–3 or no change from baseline). The pre-pathway and post-pathway groups differed in their baseline Pediatric Cerebral Performance Category scores and the following causes of arrest: airway obstruction, arrhythmias, and electrolyte abnormalities. Pathway adherence was not significan...
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Related Links:

Conclusion: Beta-adrenergic stimulation and connexin43-mediated calcium entry upon loss of plakophilin-2 function contribute to generation of delayed-afterdepolarizations. RyR2 and NCX dysregulation play a key role in modulating these proarrhythmic events. This work provides insights into potential future antiarrhythmic strategies in arrhythmogenic cardiomyopathy due to plakophilin-2 loss-of-function.
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Recently, we have read with great interest Dr. Yano and colleagues' [1] article that published in International Journal of Cardiology. In this article, they reported that paroxysmal atrial fibrillation (PAF) patients who underwent laser balloon ablation (LBA) had stronger inflammation after ablation than patients who underwent cryoballoon ablation (CBA). They further showed that LBA group had a significantly greater risk of short-term arrhythmia recurrence than CBA group. It indicated that inflammatory markers might be used to predict early arrhythmia recurrence after atrial fibrillation ablation.
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Letter to the Editor Source Type: research
ConclusionWe found no associations between markers of immunothrombosis and new-onset AF in the general population. Inflammation and immunothrombosis may be associated with AF through other cardiovascular risk factors or predisposing conditions of AF. Our findings challenge the added value of biomarkers in AF risk prediction.Graphic abstract
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Acupunct Med. 2021 Sep 23:9645284211039229. doi: 10.1177/09645284211039229. Online ahead of print.ABSTRACTBACKGROUND: To determine the effects of post-treatment electroacupuncture (EA) on the electrophysiological properties of ventricular muscle in rats with ischemia/reperfusion (IR) injury.METHODS: Male Sprague-Dawley (SD) rats were randomly assigned into sham-operated (SH), IR and IR + EA groups (n = 8 each). The IR model was generated by ligation of the left anterior descending (LAD) coronary artery for 30 min. After establishing the IR model, EA was administered at PC6 for 30 min while opening the coronary artery and a...
Source: Acupuncture in Medicine - Category: Complementary Medicine Authors: Source Type: research
Curr HIV Res. 2021 Sep 22. doi: 10.2174/1570162X19666210922154011. Online ahead of print.ABSTRACTPersons living with HIV infection (PLWH) have been recognized to have an increased risk of sudden cardiac death (SCD). Prevention of this risk should theoretically be included in their long-term management. However, only a few approaches have been proposed to optimize such interventions. Targeting detection of the commonly associated conditions such as coronary artery disease, left ventricular dysfunction, heart failure, QT interval prolongation and ventricular arrhythmias is the first step of this prevention. However, although...
Source: Current HIV Research - Category: Infectious Diseases Authors: Source Type: research
Curr Drug Saf. 2021 Sep 22. doi: 10.2174/1574886316666210922153059. Online ahead of print.ABSTRACTDrug-induced QTc prolongation is a concerning electrocardiogram (ECG) abnormality. This cardiac disturbance carries a 10% risk of sudden cardiac death due to the malignant arrhythmia, Torsades de Pointes. The Arizona Center for Education and Research on Therapeutics (AzCERT) has classified QTc prolonging therapeutic classes such as antiarrhythmics, antipsychotics, anti-infectives, and others. AzCERT criteria categorizes medications into three risk categories: "known," "possible," and "conditional risk&...
Source: Current Drug Safety - Category: Drugs & Pharmacology Authors: Source Type: research
Acupunct Med. 2021 Sep 23:9645284211039229. doi: 10.1177/09645284211039229. Online ahead of print.ABSTRACTBACKGROUND: To determine the effects of post-treatment electroacupuncture (EA) on the electrophysiological properties of ventricular muscle in rats with ischemia/reperfusion (IR) injury.METHODS: Male Sprague-Dawley (SD) rats were randomly assigned into sham-operated (SH), IR and IR + EA groups (n = 8 each). The IR model was generated by ligation of the left anterior descending (LAD) coronary artery for 30 min. After establishing the IR model, EA was administered at PC6 for 30 min while opening the coronary artery and a...
Source: Acupuncture in Medicine : journal of the British Medical Acupuncture Society - Category: Complementary Medicine Authors: Source Type: research
Curr HIV Res. 2021 Sep 22. doi: 10.2174/1570162X19666210922154011. Online ahead of print.ABSTRACTPersons living with HIV infection (PLWH) have been recognized to have an increased risk of sudden cardiac death (SCD). Prevention of this risk should theoretically be included in their long-term management. However, only a few approaches have been proposed to optimize such interventions. Targeting detection of the commonly associated conditions such as coronary artery disease, left ventricular dysfunction, heart failure, QT interval prolongation and ventricular arrhythmias is the first step of this prevention. However, although...
Source: Current HIV Research - Category: Infectious Diseases Authors: Source Type: research
Am J Nurs. 2021 Oct 1;121(10):63-66. doi: 10.1097/01.NAJ.0000794284.89236.a3.ABSTRACTEditor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.PMID:34554992 | DOI:10.1097/01.NAJ.0000794284.89236.a3
Source: The American Journal of Nursing - Category: Nursing Authors: Source Type: research
International sports eligibility recommendations, both in Europe and in North America, state that athletes with ventricular arrhythmias (VA), like premature beats (VPB) or nonsustained VT (nsVT) can participate in all forms of competitive sports if they have a structurally normal heart and no evidence of molecular/genetic or inflammatory disorders.1-3 This statement is clear, but the problem lies in its implementation: when can we decide that there is absence of structural abnormalities, channelopathy, genetic cardiomyopathy or inflammatory disease? Moreover, frequent VPB can be a marker of underlying disease.
Source: Heart Rhythm - Category: Cardiology Authors: Source Type: research
More News: Academia | Arrhythmia | Brain | Computers | Hospitals | Neurology | Pediatrics | Study