Heidrun Losert | Medical University of Vienna (original) (raw)

Papers by Heidrun Losert

Research paper thumbnail of Detection of malintubation via defibrillator pads

Resuscitation, 2008

Endotracheal intubation is the preferred method to ensure proper artificial ventilation. Early de... more Endotracheal intubation is the preferred method to ensure proper artificial ventilation. Early detection of esophageal intubation is important for an individual patient's outcome. The aim of the study was to see if impedance measurements can be used to detect esophageal intubation, using the impedance measurement system of an experimental defibrillator. Patients who died at the emergency department of a tertiary care hospital were eligible to be studied. After death was declared, patients were ventilated with a predefined tidal volume alternately via the conventional tracheal tube and via an additionally tube placed into the esophagus. The lowest and respectively highest median impedance amplitude for the first three ventilations was used as cut-off to calculate predictive values. We enrolled 10 patients (mean age 65 years (S.D. 14), 7 male) of whom 9 underwent CPR prior to death, 30% of the patients had a BMI>30. Severe lung-edema was present in 2 cases. The lowest tracheal impedance value was 0.736 ohms and the highest esophageal was 0.496 ohms. A ROC curve for this individualised approach gave an area under the curve of 1 (95% CI 0.001, 0.249). There is a large and significant reduction in transthoracic impedance when the tube is malpositioned in the esophagus. It may therefore be feasible to detect malintubation via thoracic impedance changes as an aid to improve the survival of critical ill patients. Further investigations on a larger population are needed.

Research paper thumbnail of Non-Invasive Ventilation Monitoring During Cardiopulmonary Resuscitation by Means of Thoracic Impedance

Research paper thumbnail of Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12 h after cardiac arrest might not be necessary

Resuscitation, 2008

The admission blood glucose level after cardiac arrest is predictive of outcome. However the bloo... more The admission blood glucose level after cardiac arrest is predictive of outcome. However the blood glucose levels in the post-resuscitation period, that are optimal remains a matter of debate. We wanted to assess an association between blood glucose levels at 12h after restoration of spontaneous circulation and neurological recovery over 6 months. A total of 234 patients from a multi-centre trial examining the effect of mild hypothermia on neurological outcome were included. According to the serum glucose level at 12h after restoration of spontaneous circulation, quartiles (Q) were generated: Median (range) glucose concentrations were for QI 100 (67-115 mg/dl), QII 130 (116-143 mg/dl), QIII 162 (144-193 mg/dl) and QIV 265 (194-464 mg/dl). In univariate analysis there was a strong non-linear association between blood glucose and good neurological outcome (odds ratio compared to QIV): QI 8.05 (3.03-21.4), QII 13.41 (4.9-36.67), QIII 1.88 (0.67-5.26). After adjustment for sex, age, "no-flow" and "low-flow" time, adrenaline (epinephrine) dose, history of coronary artery disease and myocardial infarction, and therapeutic hypothermia, this association still remained strong: QI 4.55 (1.28-16.12), QII 13.02 (3.29-49.9), QIII 1.37 (0.38-5.64). There is a strong non-linear association of survival with good neurological outcome and blood glucose levels 12h after cardiac arrest even after adjusting for potential confounders. Not only strict normoglycaemia, but also blood glucose levels from 116 to 143 mg/dl were correlated with survival and good neurological outcome, which might have an important therapeutic implication.

Research paper thumbnail of The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men

Resuscitation, 2004

Background: Mild therapeutic hypothermia (MTH) improves neurological outcome in patients after ca... more Background: Mild therapeutic hypothermia (MTH) improves neurological outcome in patients after cardiac arrest. From animal and human studies it appears that hypothermia impairs renal function. The aim of this study was to examine the effects of MTH on renal function in humans. Methods: Patients were participants recruited in one of the centres of the hypothermia after cardiac arrest-multicenter trial. We

Research paper thumbnail of Serial Lactate Determinations for Prediction of Outcome After Cardiac Arrest

Medicine, 2004

We investigated the relationship between lactate clearance and outcome in patients surviving the ... more We investigated the relationship between lactate clearance and outcome in patients surviving the first 48 hours after cardiac arrest. We conducted the study in the emergency department of an urban tertiary care hospital. We analyzed the data for all 48-hour survivors after successful resuscitation from cardiac arrest during a 10-year period. Serial lactate measurements, demographic data, and key cardiac arrest data were correlated to survival and best neurologic outcome within 6 months after cardiac arrest. Parameters showing significant results in univariate analysis were tested for significance in a logistic regression model. Of 1502 screened patients, 394 were analyzed. Survivors (n = 194, 49%) had lower lactate levels on admission (median, 7.8 [interquartile range, 5.4-10.8] vs 9 [6.6-11.9] mmol/L), after 24 hours (1.4 [1-2.5] vs 1.7 [1.1-3] mmol/L), and after 48 hours (1.2 [0.9-1.6] vs 1.5 [1.1-2.3] mmol/L). Patients with favorable neurologic outcome (n = 186, 47%) showed lower levels on admission (7.6 [5.4-10.3] vs 9.2 [6.7-12.1] mmol/L) and after 48 hours (1.2 [0.9-1.6] vs 1.5 [1-2.2] mmol/L). In multivariate analysis, lactate levels at 48 hours were an independent predictor for mortality (odds ratio [OR]: 1.49 increase per mmol/L, 95% confidence interval [CI]: 1.17-1.89) and unfavorable neurologic outcome (OR: 1.28 increase per mmol/L, 95% CI: 1.08-1.51). Lactate levels higher than 2 mmol/L after 48 hours predicted mortality with a specificity of 86% and poor neurologic outcome with a specificity of 87%. Sensitivity for both end points was 31%. Lactate at 48 hours after cardiac arrest is an independent predictor of mortality and unfavorable neurologic outcome. Persisting hyperlactatemia over 48 hours predicts a poor prognosis.

Research paper thumbnail of Hypothermia after cardiac arrest: a treatment that works

Current Opinion in Critical Care, 2003

Sudden death from cardiac arrest is a major health problem that still receives too little publici... more Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts because, until now, no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome.

Research paper thumbnail of Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism

Resuscitation, 2003

Objective: Thrombolytic therapy in patients with massive pulmonary embolism (MPE) and prolonged c... more Objective: Thrombolytic therapy in patients with massive pulmonary embolism (MPE) and prolonged cardiopulmonary resuscitation (CPR) is subject to debate. This study was performed to determine whether (1) thrombolytic treatment increases the risk of bleeding complications, (2) if the risk of bleeding is influenced by the duration of CPR and if (3) thrombolytic therapy improves outcome. Design: Retrospective cohort study. Setting:

Research paper thumbnail of Automated external defibrillators and the European Resuscitation Guidelines 2005

Research paper thumbnail of Quality of cardiopulmonary resuscitation among highly trained staff in an emergency department setting

Archives of internal medicine, Jan 27, 2006

Recent reports have highlighted the poor standard of cardiopulmonary resuscitation (CPR) achieved... more Recent reports have highlighted the poor standard of cardiopulmonary resuscitation (CPR) achieved by health care professionals in diverse situations. We explored what can be achieved in an emergency department by highly trained permanent staff. In a prospective observational study conducted from June 1, 2002, to August 31, 2005, 80 of 213 patients requiring CPR and admitted to the emergency department of a tertiary care hospital were eligible for study participation. Owing to several logistic problems with CPR, 133 patients could not be studied. The CPR team consisted of emergency- and critical care-trained physicians with more than 10 years of acute care experience, most of whom were instructors of European Resuscitation Council courses in basic and advanced life support. A specially designed defibrillator was used to assess the quality of CPR. For 80 patients, 95 data sets were available for analysis, yielding a total of 1065 minutes of cardiac arrest time. Chest compressions were...

Research paper thumbnail of Survivors of ventricular tachyarrhythmias due to a transient or reversible disorder have a high recurrence rate of lethal cardiac events

Resuscitation, 2002

The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in pa... more The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in patients not having received an implantable cardioverter defibrillator (ICD) is investigated. According to current guidelines, only a small percentage of patients after successful cardiopulmonary resuscitation due to an underlying cardiac problem are eligible for the implantation of an ICD. For retrospective analysis, we used a data registry of patients admitted to an emergency department after cardiac arrest. Patients who had a primary cardiac cause for their cardiac arrest and who did not die within the first month after successful restoration of spontaneous circulation were selected. From 1246 patients, 360 met the inclusion criteria. A second lethal cardiac event occurred in 94 (26%). Of those 94 patients, 57 (61%) had good neurological function before their second cardiac arrest. Of the survivors with good neurological function, 47 (82%) did not have an ICD or a cardiac transplant. An...

Research paper thumbnail of Hypothermia after cardiac arrest: a treatment that works

Current Opinion in Critical Care, 2003

Sudden death from cardiac arrest is a major health problem that still receives too little publici... more Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts because, until now, no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome.

Research paper thumbnail of Can brain natriuretic peptide predict outcome after cardiac arrest? An observational study

Resuscitation, 2007

Risk of death is high in patients with pulmonary embolism (PE) because of right ventricular (RV) ... more Risk of death is high in patients with pulmonary embolism (PE) because of right ventricular (RV) failure. Plasma levels of brain natriuretic peptide (BNP) are increased in cases of isolated chronic right ventricular dysfunction (RVD) and chronic pulmonary hypertension. However, little is known about BNP secretion during acute RVD caused by acute PE.

Research paper thumbnail of Closed Suctioning System Reduces Cross-Contamination Between Bronchial System and Gastric Juices

In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (Trac... more In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (Trach- Care™) influences crossover contamination between bronchial system and gastric juices when compared with an open suctioning system (OS). The secondary aims were an analysis of the frequency of ventilator- associated pneumonia (VAP) and an analysis of alter- ation in gas exchange. Antibiograms were performed from tracheal

Research paper thumbnail of Therapeutic hypothermia after cardiac arrest

Current Opinion in Critical Care, 2001

This review discusses the mechanisms of neurologic damage during and after global cerebral ischem... more This review discusses the mechanisms of neurologic damage during and after global cerebral ischemia caused by cardiac arrest. The different pathways of membrane destruction by radicals, free fatty acids, excitatory amino acids (neurotransmit- ters), calcium, glucose metabolism, and oxygen availability and demand in relation to metabolic rate are briefly discussed. The main focus of this review paper, however, lies in

Research paper thumbnail of Survivors of cardiac arrest with good neurological outcome show considerable impairments of memory functioning

Resuscitation, 2014

Background: Deficits in cognitive function are a well-known dysfunction in survivors of cardiac a... more Background: Deficits in cognitive function are a well-known dysfunction in survivors of cardiac arrest. However, data concerning memory function in this neurological vulnerable patient collective remain scarce and inconclusive. Therefore, we aimed to assess multiple aspects of retrospective and prospective memory performance in patients after cardiac arrest. Methods: We prospectively enrolled 33 survivors of cardiac arrest, with cerebral performance categories (CPC) 1 and 2 and a control-group (n = 33) matched in sex, age and educational-level. To assess retrospective and prospective memory performance we administrated 4 weeks after cardiac arrest the "Rey Adult Learning Test" (RAVLT), the "Digit-Span-Backwards Test", the "Logic-Memory Test" and the "Red-Pencil Test". Results: Results indicate an impairment in immediate and delayed free recall, but not in recognition. However, the overall impairment in immediate recall was qualified by analyzing RAVLT performance, showing that patients were only impaired in trials 4 and 5 of the learning sequence. Moreover, working and prospective memory as well as prose recall were worse in cardiac arrest survivors. Cranial computed tomography was available in 61% of all patients (n = 20) but there was no specific neurological damage detectable that could be linked to this cognitive impairment. Conclusion: Episodic long-term memory functioning appears to be particularly impaired after cardiac arrest. In contrast, short-term memory storage, even tested via free-call, seems not to be affected. Based on cranial computed tomography we suggest that global brain ischemia rather than focal brain lesions appear to underlie these effects.

Research paper thumbnail of A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic

Wiener klinische Wochenschrift, 2011

We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome wh... more We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.

Research paper thumbnail of Cardiopulmonary resuscitation and the 2005 universal algorithm: Has the quality of CPR improved?

Wiener klinische Wochenschrift, 2009

Zusammenfassung. Hintergrund: Eine optimale Herz-Druck-Massage stellt die Grundlage jeder erfolgr... more Zusammenfassung. Hintergrund: Eine optimale Herz-Druck-Massage stellt die Grundlage jeder erfolgreichen Reanimation dar. Das ideale Verhältnis von Thoraxkompressionen zu Atemspenden ist weiterhin Gegenstand von Untersuchungen, die Wichtigkeit des sofortigen Beginnes einer ausreichend tiefen Herzdruckmassage nach Eintreten des Herzkreislaufstillstandes sowie die Reduktion von Unterbrechungen der Herzdruckmassage ist jedoch eindeutig bewiesen. Im Jahr 2005 wurden die Richtlinien für Basisreanimationsmaßnahmen durch das European Resuscitation Council grundlegend verändert. Ziel war es, Unterbrechungen der Herz-Druck-Massage zu minimieren. Im Rahmen der vorliegenden Studie wurden Ersthelferreanimationen am Übungsphantom nach den Richtlinien 2000 mit jenen von 2005 verglichen. Methoden: Nach positivem Votum der Ethikkommission wurde die Studie im randomisierten cross-over Design durchgeführt. Teilnehmer wurden nach einer jeweils zehn Minuten dauernden Unterrichts-und Übungsperiode aufgefordert, fünf Minuten Basisreanimation am Übungsphantom durchzuführen. Endpunkte der Studie waren die hands-off-Zeit (Zeit im Herzkreislaufstillstand ohne Herzdruckmassage) sowie Gesamtzahl der Thoraxkompressionen. Ergebnis: Fünfzig Probanden wurden eingeschlossen, eine Probandin zog sich nach der Randomisierung aus der Studie zurück. Die hands-off-Zeit war unter den Reanimationsrichtlinien 2005 signifikant kürzer als unter den Richtlinien 2000 (MW ± SD: 107 ± 19 sec vs. 139 ± 15 sec.; p < 0.0001). Weiters war auch die Gesamtzahl der Thoraxkompressionen unter den Reanimatiwkw 1-2/2009 Quality of CPR and the 2005 universal algorithm original article 42 proved with basic life support performed according to the ERC guidelines of 2005.

Research paper thumbnail of Efficacy and Safety of Endovascular Cooling After Cardiac Arrest: Cohort Study and Bayesian Approach

Stroke, 2006

Background and Purpose-Recently 2 randomized trials in comatose survivors of cardiac arrest docum... more Background and Purpose-Recently 2 randomized trials in comatose survivors of cardiac arrest documented that therapeutic hypothermia improved neurological recovery. The narrow inclusion criteria resulted in an international recommendation to cool only a restricted group of primary cardiac arrest survivors. In this retrospective cohort study we investigated the efficacy and safety of endovascular cooling in unselected survivors of cardiac arrest. Methods-Consecutive comatose survivors of cardiac arrest, who were either cooled for 24 hours to 33°C with endovascular cooling or treated with standard postresuscitation therapy, were analyzed. Complication data were obtained by retrospective chart review.

Research paper thumbnail of Mild therapeutic hypothermia improves outcome in patients suffering cardiac arrest from non-shockable rhyhtms

Resuscitation, 2010

1. Although the electrocradiogram (ECG) is a widely used and crucial tool in emergency medicine t... more 1. Although the electrocradiogram (ECG) is a widely used and crucial tool in emergency medicine there is only little data evaluating its role in therapy decision after return of spontaneous circulation (ROSC). 1 Furthermore many resuscitation related factors (RLF), e.g. global hypoxemia, defibrillation, high-dose drugs, chest compression and hypothermia, are known to cause ECG changes.

Research paper thumbnail of Nasal cooling with a new cooling device in patients after cardiac arrest and successful resuscitation

Research paper thumbnail of Detection of malintubation via defibrillator pads

Resuscitation, 2008

Endotracheal intubation is the preferred method to ensure proper artificial ventilation. Early de... more Endotracheal intubation is the preferred method to ensure proper artificial ventilation. Early detection of esophageal intubation is important for an individual patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s outcome. The aim of the study was to see if impedance measurements can be used to detect esophageal intubation, using the impedance measurement system of an experimental defibrillator. Patients who died at the emergency department of a tertiary care hospital were eligible to be studied. After death was declared, patients were ventilated with a predefined tidal volume alternately via the conventional tracheal tube and via an additionally tube placed into the esophagus. The lowest and respectively highest median impedance amplitude for the first three ventilations was used as cut-off to calculate predictive values. We enrolled 10 patients (mean age 65 years (S.D. 14), 7 male) of whom 9 underwent CPR prior to death, 30% of the patients had a BMI&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30. Severe lung-edema was present in 2 cases. The lowest tracheal impedance value was 0.736 ohms and the highest esophageal was 0.496 ohms. A ROC curve for this individualised approach gave an area under the curve of 1 (95% CI 0.001, 0.249). There is a large and significant reduction in transthoracic impedance when the tube is malpositioned in the esophagus. It may therefore be feasible to detect malintubation via thoracic impedance changes as an aid to improve the survival of critical ill patients. Further investigations on a larger population are needed.

Research paper thumbnail of Non-Invasive Ventilation Monitoring During Cardiopulmonary Resuscitation by Means of Thoracic Impedance

Research paper thumbnail of Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12 h after cardiac arrest might not be necessary

Resuscitation, 2008

The admission blood glucose level after cardiac arrest is predictive of outcome. However the bloo... more The admission blood glucose level after cardiac arrest is predictive of outcome. However the blood glucose levels in the post-resuscitation period, that are optimal remains a matter of debate. We wanted to assess an association between blood glucose levels at 12h after restoration of spontaneous circulation and neurological recovery over 6 months. A total of 234 patients from a multi-centre trial examining the effect of mild hypothermia on neurological outcome were included. According to the serum glucose level at 12h after restoration of spontaneous circulation, quartiles (Q) were generated: Median (range) glucose concentrations were for QI 100 (67-115 mg/dl), QII 130 (116-143 mg/dl), QIII 162 (144-193 mg/dl) and QIV 265 (194-464 mg/dl). In univariate analysis there was a strong non-linear association between blood glucose and good neurological outcome (odds ratio compared to QIV): QI 8.05 (3.03-21.4), QII 13.41 (4.9-36.67), QIII 1.88 (0.67-5.26). After adjustment for sex, age, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;no-flow&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;low-flow&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; time, adrenaline (epinephrine) dose, history of coronary artery disease and myocardial infarction, and therapeutic hypothermia, this association still remained strong: QI 4.55 (1.28-16.12), QII 13.02 (3.29-49.9), QIII 1.37 (0.38-5.64). There is a strong non-linear association of survival with good neurological outcome and blood glucose levels 12h after cardiac arrest even after adjusting for potential confounders. Not only strict normoglycaemia, but also blood glucose levels from 116 to 143 mg/dl were correlated with survival and good neurological outcome, which might have an important therapeutic implication.

Research paper thumbnail of The effect of mild therapeutic hypothermia on renal function after cardiopulmonary resuscitation in men

Resuscitation, 2004

Background: Mild therapeutic hypothermia (MTH) improves neurological outcome in patients after ca... more Background: Mild therapeutic hypothermia (MTH) improves neurological outcome in patients after cardiac arrest. From animal and human studies it appears that hypothermia impairs renal function. The aim of this study was to examine the effects of MTH on renal function in humans. Methods: Patients were participants recruited in one of the centres of the hypothermia after cardiac arrest-multicenter trial. We

Research paper thumbnail of Serial Lactate Determinations for Prediction of Outcome After Cardiac Arrest

Medicine, 2004

We investigated the relationship between lactate clearance and outcome in patients surviving the ... more We investigated the relationship between lactate clearance and outcome in patients surviving the first 48 hours after cardiac arrest. We conducted the study in the emergency department of an urban tertiary care hospital. We analyzed the data for all 48-hour survivors after successful resuscitation from cardiac arrest during a 10-year period. Serial lactate measurements, demographic data, and key cardiac arrest data were correlated to survival and best neurologic outcome within 6 months after cardiac arrest. Parameters showing significant results in univariate analysis were tested for significance in a logistic regression model. Of 1502 screened patients, 394 were analyzed. Survivors (n = 194, 49%) had lower lactate levels on admission (median, 7.8 [interquartile range, 5.4-10.8] vs 9 [6.6-11.9] mmol/L), after 24 hours (1.4 [1-2.5] vs 1.7 [1.1-3] mmol/L), and after 48 hours (1.2 [0.9-1.6] vs 1.5 [1.1-2.3] mmol/L). Patients with favorable neurologic outcome (n = 186, 47%) showed lower levels on admission (7.6 [5.4-10.3] vs 9.2 [6.7-12.1] mmol/L) and after 48 hours (1.2 [0.9-1.6] vs 1.5 [1-2.2] mmol/L). In multivariate analysis, lactate levels at 48 hours were an independent predictor for mortality (odds ratio [OR]: 1.49 increase per mmol/L, 95% confidence interval [CI]: 1.17-1.89) and unfavorable neurologic outcome (OR: 1.28 increase per mmol/L, 95% CI: 1.08-1.51). Lactate levels higher than 2 mmol/L after 48 hours predicted mortality with a specificity of 86% and poor neurologic outcome with a specificity of 87%. Sensitivity for both end points was 31%. Lactate at 48 hours after cardiac arrest is an independent predictor of mortality and unfavorable neurologic outcome. Persisting hyperlactatemia over 48 hours predicts a poor prognosis.

Research paper thumbnail of Hypothermia after cardiac arrest: a treatment that works

Current Opinion in Critical Care, 2003

Sudden death from cardiac arrest is a major health problem that still receives too little publici... more Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts because, until now, no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome.

Research paper thumbnail of Major bleeding complications in cardiopulmonary resuscitation: the place of thrombolytic therapy in cardiac arrest due to massive pulmonary embolism

Resuscitation, 2003

Objective: Thrombolytic therapy in patients with massive pulmonary embolism (MPE) and prolonged c... more Objective: Thrombolytic therapy in patients with massive pulmonary embolism (MPE) and prolonged cardiopulmonary resuscitation (CPR) is subject to debate. This study was performed to determine whether (1) thrombolytic treatment increases the risk of bleeding complications, (2) if the risk of bleeding is influenced by the duration of CPR and if (3) thrombolytic therapy improves outcome. Design: Retrospective cohort study. Setting:

Research paper thumbnail of Automated external defibrillators and the European Resuscitation Guidelines 2005

Research paper thumbnail of Quality of cardiopulmonary resuscitation among highly trained staff in an emergency department setting

Archives of internal medicine, Jan 27, 2006

Recent reports have highlighted the poor standard of cardiopulmonary resuscitation (CPR) achieved... more Recent reports have highlighted the poor standard of cardiopulmonary resuscitation (CPR) achieved by health care professionals in diverse situations. We explored what can be achieved in an emergency department by highly trained permanent staff. In a prospective observational study conducted from June 1, 2002, to August 31, 2005, 80 of 213 patients requiring CPR and admitted to the emergency department of a tertiary care hospital were eligible for study participation. Owing to several logistic problems with CPR, 133 patients could not be studied. The CPR team consisted of emergency- and critical care-trained physicians with more than 10 years of acute care experience, most of whom were instructors of European Resuscitation Council courses in basic and advanced life support. A specially designed defibrillator was used to assess the quality of CPR. For 80 patients, 95 data sets were available for analysis, yielding a total of 1065 minutes of cardiac arrest time. Chest compressions were...

Research paper thumbnail of Survivors of ventricular tachyarrhythmias due to a transient or reversible disorder have a high recurrence rate of lethal cardiac events

Resuscitation, 2002

The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in pa... more The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in patients not having received an implantable cardioverter defibrillator (ICD) is investigated. According to current guidelines, only a small percentage of patients after successful cardiopulmonary resuscitation due to an underlying cardiac problem are eligible for the implantation of an ICD. For retrospective analysis, we used a data registry of patients admitted to an emergency department after cardiac arrest. Patients who had a primary cardiac cause for their cardiac arrest and who did not die within the first month after successful restoration of spontaneous circulation were selected. From 1246 patients, 360 met the inclusion criteria. A second lethal cardiac event occurred in 94 (26%). Of those 94 patients, 57 (61%) had good neurological function before their second cardiac arrest. Of the survivors with good neurological function, 47 (82%) did not have an ICD or a cardiac transplant. An...

Research paper thumbnail of Hypothermia after cardiac arrest: a treatment that works

Current Opinion in Critical Care, 2003

Sudden death from cardiac arrest is a major health problem that still receives too little publici... more Sudden death from cardiac arrest is a major health problem that still receives too little publicity. Current therapy after cardiac arrest concentrates on resuscitation efforts because, until now, no specific therapy for brain protection after restoration of spontaneous circulation was available. Therapeutic mild or moderate resuscitative hypothermia is a novel therapy with multifaceted chemical and physical effects by preventing or mitigating the derangements seen in the postresuscitation syndrome.

Research paper thumbnail of Can brain natriuretic peptide predict outcome after cardiac arrest? An observational study

Resuscitation, 2007

Risk of death is high in patients with pulmonary embolism (PE) because of right ventricular (RV) ... more Risk of death is high in patients with pulmonary embolism (PE) because of right ventricular (RV) failure. Plasma levels of brain natriuretic peptide (BNP) are increased in cases of isolated chronic right ventricular dysfunction (RVD) and chronic pulmonary hypertension. However, little is known about BNP secretion during acute RVD caused by acute PE.

Research paper thumbnail of Closed Suctioning System Reduces Cross-Contamination Between Bronchial System and Gastric Juices

In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (Trac... more In this prospective, randomized study, we evaluated whether a closed suctioning (CS) system (Trach- Care™) influences crossover contamination between bronchial system and gastric juices when compared with an open suctioning system (OS). The secondary aims were an analysis of the frequency of ventilator- associated pneumonia (VAP) and an analysis of alter- ation in gas exchange. Antibiograms were performed from tracheal

Research paper thumbnail of Therapeutic hypothermia after cardiac arrest

Current Opinion in Critical Care, 2001

This review discusses the mechanisms of neurologic damage during and after global cerebral ischem... more This review discusses the mechanisms of neurologic damage during and after global cerebral ischemia caused by cardiac arrest. The different pathways of membrane destruction by radicals, free fatty acids, excitatory amino acids (neurotransmit- ters), calcium, glucose metabolism, and oxygen availability and demand in relation to metabolic rate are briefly discussed. The main focus of this review paper, however, lies in

Research paper thumbnail of Survivors of cardiac arrest with good neurological outcome show considerable impairments of memory functioning

Resuscitation, 2014

Background: Deficits in cognitive function are a well-known dysfunction in survivors of cardiac a... more Background: Deficits in cognitive function are a well-known dysfunction in survivors of cardiac arrest. However, data concerning memory function in this neurological vulnerable patient collective remain scarce and inconclusive. Therefore, we aimed to assess multiple aspects of retrospective and prospective memory performance in patients after cardiac arrest. Methods: We prospectively enrolled 33 survivors of cardiac arrest, with cerebral performance categories (CPC) 1 and 2 and a control-group (n = 33) matched in sex, age and educational-level. To assess retrospective and prospective memory performance we administrated 4 weeks after cardiac arrest the "Rey Adult Learning Test" (RAVLT), the "Digit-Span-Backwards Test", the "Logic-Memory Test" and the "Red-Pencil Test". Results: Results indicate an impairment in immediate and delayed free recall, but not in recognition. However, the overall impairment in immediate recall was qualified by analyzing RAVLT performance, showing that patients were only impaired in trials 4 and 5 of the learning sequence. Moreover, working and prospective memory as well as prose recall were worse in cardiac arrest survivors. Cranial computed tomography was available in 61% of all patients (n = 20) but there was no specific neurological damage detectable that could be linked to this cognitive impairment. Conclusion: Episodic long-term memory functioning appears to be particularly impaired after cardiac arrest. In contrast, short-term memory storage, even tested via free-call, seems not to be affected. Based on cranial computed tomography we suggest that global brain ischemia rather than focal brain lesions appear to underlie these effects.

Research paper thumbnail of A surge of flu-associated adult respiratory distress syndrome in an Austrian tertiary care hospital during the 2009/2010 Influenza A H1N1v pandemic

Wiener klinische Wochenschrift, 2011

We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome wh... more We report on 17 patients with influenza A H1N1v-associated Adult Respiratory Distress Syndrome who were admitted to the intensive care unit (ICU) between June 11th 2009 and August 10th 2010 (f/m: 8/9; age: median 39 (IQR 29-54) years; SAPS II: 35 (29-48)). Body mass index was 26 (24-35), 24% were overweight and 29% obese. The Charlson Comorbidity Index was 1 (0-2) and all but one patient had comorbid conditions. The median time between onset of the first symptom and admission to the ICU was 5 days (range 0-14). None of the patients had received vaccination against H1N1v. Nine patients received oseltamivir, only two of them within 48 hours of symptom onset. All patients developed severe ARDS (PaO(2)/FiO(2)-Ratio 60 (55-92); lung injury score 3.8 (3.3-4.0)), were mechanically ventilated and on vasopressor support. Fourteen patients received corticosteroids, 7 patients underwent hemofiltration, and 10 patients needed extracorporeal membrane-oxygenation (ECMO; 8 patients veno-venous, 2 patients veno-arterial), three patients Interventional Lung Assist (ILA) and two patients pump driven extracorporeal low-flow CO(2)-elimination (ECCO(2)-R). Seven of 17 patients (41%) died in the ICU (4 patients due to bleeding, 3 patients due to multi-organ failure), while all other patients survived the hospital (59%). ECMO mortality was 50%. The median ICU length-of-stay was 26 (19-44) vs. 21 (17-25) days (survivors vs. nonsurvivors), days on the ventilator were 18 (14-35) vs. 20 (17-24), and ECMO duration was 10 (8-25) vs. 13 (11-16) days, respectively (all p = n.s.). Compared to a control group of 241 adult intensive care unit patients without H1N1v, length of stay in the ICU, rate of mechanical ventilation, days on the ventilator, and TISS 28 scores were significantly higher in patients with H1N1v. The ICU survival tended to be higher in control patients (79 vs. 59%; p = 0.06). Patients with H1N1v admitted to either of our ICUs were young, overproportionally obese and almost all with existing comorbidities. All patients developed severe ARDS, which could only be treated with extracorporeal gas exchange in an unexpectedly high proportion. Patients with H1N1v had more complicated courses compared to control patients.

Research paper thumbnail of Cardiopulmonary resuscitation and the 2005 universal algorithm: Has the quality of CPR improved?

Wiener klinische Wochenschrift, 2009

Zusammenfassung. Hintergrund: Eine optimale Herz-Druck-Massage stellt die Grundlage jeder erfolgr... more Zusammenfassung. Hintergrund: Eine optimale Herz-Druck-Massage stellt die Grundlage jeder erfolgreichen Reanimation dar. Das ideale Verhältnis von Thoraxkompressionen zu Atemspenden ist weiterhin Gegenstand von Untersuchungen, die Wichtigkeit des sofortigen Beginnes einer ausreichend tiefen Herzdruckmassage nach Eintreten des Herzkreislaufstillstandes sowie die Reduktion von Unterbrechungen der Herzdruckmassage ist jedoch eindeutig bewiesen. Im Jahr 2005 wurden die Richtlinien für Basisreanimationsmaßnahmen durch das European Resuscitation Council grundlegend verändert. Ziel war es, Unterbrechungen der Herz-Druck-Massage zu minimieren. Im Rahmen der vorliegenden Studie wurden Ersthelferreanimationen am Übungsphantom nach den Richtlinien 2000 mit jenen von 2005 verglichen. Methoden: Nach positivem Votum der Ethikkommission wurde die Studie im randomisierten cross-over Design durchgeführt. Teilnehmer wurden nach einer jeweils zehn Minuten dauernden Unterrichts-und Übungsperiode aufgefordert, fünf Minuten Basisreanimation am Übungsphantom durchzuführen. Endpunkte der Studie waren die hands-off-Zeit (Zeit im Herzkreislaufstillstand ohne Herzdruckmassage) sowie Gesamtzahl der Thoraxkompressionen. Ergebnis: Fünfzig Probanden wurden eingeschlossen, eine Probandin zog sich nach der Randomisierung aus der Studie zurück. Die hands-off-Zeit war unter den Reanimationsrichtlinien 2005 signifikant kürzer als unter den Richtlinien 2000 (MW ± SD: 107 ± 19 sec vs. 139 ± 15 sec.; p < 0.0001). Weiters war auch die Gesamtzahl der Thoraxkompressionen unter den Reanimatiwkw 1-2/2009 Quality of CPR and the 2005 universal algorithm original article 42 proved with basic life support performed according to the ERC guidelines of 2005.

Research paper thumbnail of Efficacy and Safety of Endovascular Cooling After Cardiac Arrest: Cohort Study and Bayesian Approach

Stroke, 2006

Background and Purpose-Recently 2 randomized trials in comatose survivors of cardiac arrest docum... more Background and Purpose-Recently 2 randomized trials in comatose survivors of cardiac arrest documented that therapeutic hypothermia improved neurological recovery. The narrow inclusion criteria resulted in an international recommendation to cool only a restricted group of primary cardiac arrest survivors. In this retrospective cohort study we investigated the efficacy and safety of endovascular cooling in unselected survivors of cardiac arrest. Methods-Consecutive comatose survivors of cardiac arrest, who were either cooled for 24 hours to 33°C with endovascular cooling or treated with standard postresuscitation therapy, were analyzed. Complication data were obtained by retrospective chart review.

Research paper thumbnail of Mild therapeutic hypothermia improves outcome in patients suffering cardiac arrest from non-shockable rhyhtms

Resuscitation, 2010

1. Although the electrocradiogram (ECG) is a widely used and crucial tool in emergency medicine t... more 1. Although the electrocradiogram (ECG) is a widely used and crucial tool in emergency medicine there is only little data evaluating its role in therapy decision after return of spontaneous circulation (ROSC). 1 Furthermore many resuscitation related factors (RLF), e.g. global hypoxemia, defibrillation, high-dose drugs, chest compression and hypothermia, are known to cause ECG changes.

Research paper thumbnail of Nasal cooling with a new cooling device in patients after cardiac arrest and successful resuscitation