Cardiac arrest is an important public health issue, with a survival rate of approximately 15 to 22%. A great proportion of these deaths occur after resuscitation due to post-cardiac arrest syndrome, which is characterized by the ischemia-reperfusion injury that affects the role body. Understanding physiopathology is mandatory to discover new treatment strategies and obtain better results. Besides improvements in cardiopulmonary resuscitation maneuvers, the great increase in survival rates observed in recent decades is due to new approaches to post-cardiac arrest care. In this review, we will discuss physiopathology, etiologies, and post-resuscitation care, emphasizing targeted temperature management, early coronary angiography, and rehabilitation.
27 April 2024 in The American Journal of the Medical Sciences
Background: Patients with acute heart failure exhibit high rates of early rehospitalization accompanied by significant mortality. Therefore, identifying high-risk patients who are prone to disease exacerbation may enable early therapeutic interventions for improved disease management. Methods: This single-center, prospective observational study was conducted at a Brazilian hospital. Adult patients hospitalized for acute heart failure were enrolled. On the day of hospital discharge, NT-pro-BNP and body weight data were collected, and bedside lung and inferior vena cava ultrasound examinations were performed. The patients were followed up for up to 30 days after discharge. The primary outcome was rehospitalization for acute heart failure. Results: A total of 100 patients were included in the final analysis, of whom 10% were readmitted within 30 days owing to acute heart failure. The number of patients with total B-line scores >3 in the readmitted and non-readmitted groups was 6 and 19, respectively (60% and 21%, respectively; absolute risk difference: 39%; p = 0.014). The mean inferior vena cava collapsibility index was significantly lower in readmitted compared to that in non-readmitted patients (25.5% vs. 39.8%, standard deviation: 15.4% and 18.4%, respectively; p = 0.020). However, mean body weight and mean NT-pro-BNP levels at discharge did not differ between the groups. In a multivariate logistic regression model adjusted for sex, age, discharge body weight, and left ventricular ejection fraction, a total B-lines score >3 had an odds ratio of 4.72 (95% confidence interval (CI): 1.01–22.13; p = 0.049), while the inferior vena cava collapsibility index had an odds ratio of 0.96 (95% CI: 0.91–1.01; p = 0.091). Conclusions: A total B-line score >3 at discharge in patients hospitalized for acute heart failure was associated with 30-day rehospitalization. In contrast, inferior vena cava ultrasound, discharge body weight, and NT-pro-BNP at discharge were not significant predictors of rehospitalization.
In-hospital cardiac arrest is a critical medical emergency. Knowledge of prognostic factors could assist in cardiopulmonary resuscitation decision-making. Frailty and functional status are emerging risk factors and may play a role in prognostication. The objective was to evaluate the association between reduced mobility and in-hospital cardiac arrest outcomes.