Clinical predictors of survival in patients treated with therapeutic hypothermia following cardiac arrest

From Resuscitation:

Therapeutic hypothermia has been shown to provide neuroprotection and improved survival in patients suffering a cardiac arrest. We report outcomes of consecutive patients receiving therapeutic hypothermia for cardiac arrest and describe predictors of short and long-term survival.

Methods: Eighty patients receiving therapeutic hypothermia between January 2005 and December 2008 were identified and categorized as those who survived and died. Outcomes and predictors of survival were determined.

Results: Forty-five patients (56%) survived to hospital discharge and were alive at 30 days and among survivors 41 (91%) were alive 1 year after discharge. Survivors were younger, were more likely to present with VF, required less epinephrine during resuscitation, were more likely to have preserved renal function, and were less likely to be taking beta-blockers and ACE inhibitors. Predictors of survival included VF on presentation (OR 14.9, CI 2.7–83.2, p=0.002), pre-cardiac arrest aspirin use (OR 9.7, CI 1.6–61.1, p=0.02), return of spontaneous circulation <20min (OR 9.4, CI 2.2–41.1, p=0.003), absence of coronary artery disease (OR 5.3, CI 1.1–24.7, p=0.002) and preserved renal function.

Conclusion:  Therapeutic hypothermia is useful in the treatment of patients suffering a cardiac arrest. Several clinical factors may aid in predicting patients who are likely to survive after a cardiac arrest.

Antagonistic people have thicker carotid walls, increased CVD risk

From The HeartWire:

Antagonistic people, particularly those who are competitive and aggressive, could be increasing their risk of MI or stroke, new research indicates.

Studying more than 5000 people in Sardinia, Italy, US scientists found that those who scored high for antagonistic traits on a standard personality test had greater thickening of the carotid arteries on ultrasound compared with people who were more agreeable. Intima-media thickness (IMT) of the carotid artery is an independent risk factor for cardiovascular events, say Dr Angelina R Sutin (National Institute on Aging, Baltimore, MD) and colleagues in their paper published online August 16, 2010 in Hypertension.

“We found that although men tended to have thicker arterial walls than women, antagonistic women had [thickness of] arterial walls similar to that of antagonistic men,” Sutin told heartwire. “So the association between antagonism and arterial thickness was much stronger for women.” And although arterial thickening is a sign of aging, young people with antagonistic traits already had such thickening, even after controlling for confounding factors such as smoking, she said.

She cautions, however, that this was a population-based sample and more research needs to be done in clinical settings. Nevertheless, doctors might want to consider antagonism and other facets of personality traits when assessing an individual’s risk, she says. The study results could help determine who might benefit from targeted interventions such as anger management, for example.

ER visits for gastro illnesses spike after heavy rains, study finds

From Environmental Health News:

Heavy rainfall can lead to an 11 percent increase in children’s emergency room visits for gastro illnesses, suggesting microbes from sewage may contaminate drinking water supplies.

During heavy rainfall, disease-causing microbes usually relegated to sewage water can enter surface or ground water used for drinking and drive up emergency room visits for gastrointestinal problems, say researchers who compared children’s hospital visits and rainfall for five years in Wisconsin.

The exposures through drinking water could be an important – and perhaps underestimated – path that makes kids ill. In the United States, each year, there are approximately 19 million cases of gastrointestinal illness that are potentially related to contamination of public drinking water systems. Diarrhea, vomiting, and other stomach problems are common types of gastrointestinal illness. Because global climate change is expected to cause heavier precipitation in some areas, it is important to understand the link between more rain and increased incidence of waterborne disease.

Viruses, and to a lesser degree, bacteria are the main causes of gastrointestinal illness among children. These microbes are found in waterways used for drinking water, and their numbers increase following storms, the researchers explain in their paper.

Rhinochill Study

From EMS Responder:

New Intra-Nasal Cooling System May Improve Survival When Initiated Soon After Cardiac Arrest

A new portable system which cools the brain via the nasal cavity may improve survival following cardiac arrest compared with standard care procedures, particularly when CPR and cooling are initiated early.

Results from a recent study showed that the RhinoChill(TM) Intra-Nasal Cooling System enabled brain temperature to reach target several hours earlier than patients cooled in the emergency room. It is widely recognized that the sooner brain temperature can be reduced, the better the chances of minimizing long-term damage.

The study, published online in the prestigious peer-reviewed journal Circulation, is the first to evaluate cooling using this system in a randomized protocol conducted in the field and during the arrest. The Pre-Resuscitation Intra-Nasal Cooling Effectiveness (PRINCE) study involved 200 patients with witnessed cardiac arrest across 15 locations in Belgium, Germany, Italy, Czech Republic and Sweden, where cardiopulmonary resuscitation (CPR) had been initiated within 20 minutes of collapse. Patients were randomized to either intra-nasal cooling with RhinoChill along with standard advanced cardiac life support (ACLS) care or ACLS alone until they were either resuscitated or reached hospital, at which stage patients in both groups were cooled.