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  1. Article ; Online: Extracorporeal Membrane Oxygenation for Cardiogenic Shock: When to Open the Parachute?

    Henry, Timothy D / Yannopoulos, Demetri / van Diepen, Sean

    Circulation

    2023  Volume 147, Issue 6, Page(s) 465–468

    MeSH term(s) Humans ; Shock, Cardiogenic/diagnosis ; Shock, Cardiogenic/therapy ; Extracorporeal Membrane Oxygenation
    Language English
    Publishing date 2023-02-06
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 80099-5
    ISSN 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
    ISSN (online) 1524-4539
    ISSN 0009-7322 ; 0069-4193 ; 0065-8499
    DOI 10.1161/CIRCULATIONAHA.122.063190
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Randomized controlled dose-escalation design to evaluate the safety of a novel pharmacological cardiopulmonary resuscitation strategy.

    Benson, Sydney / Yannopoulos, Demetri / Aufderheide, Tom P / Murray, Thomas A

    Clinical trials (London, England)

    2023  Volume 20, Issue 6, Page(s) 681–688

    Abstract: Background/aims: The motivating randomized controlled phase I trial evaluates three sodium nitroprusside doses in a novel sodium nitroprusside-enhanced cardiopulmonary resuscitation strategy for improved end-organ perfusion relative to local standard of ...

    Abstract Background/aims: The motivating randomized controlled phase I trial evaluates three sodium nitroprusside doses in a novel sodium nitroprusside-enhanced cardiopulmonary resuscitation strategy for improved end-organ perfusion relative to local standard of care. Sodium nitroprusside is a vasodilator with an established safety profile in other indications, whereas the local standard of care uses vasoconstrictors, typically epinephrine. The purpose of the proposed trial is to identify the highest safe dose of sodium nitroprusside in this new context as excessive doses may cause severe hypotension with compromised end-organ perfusion.
    Methods: The proposed phase I trial design expands upon traditional dose-finding designs to include a randomized control arm, which is needed to assess safety through the relative increase in serum lactate on hospital admission. For guiding dose escalation, we propose and compare six Bayesian models which characterize expected serum lactate as a function of sodium nitroprusside dose and randomization group. Each model makes a different assumption about the expected change in serum lactate across control cohorts concurrently randomized with each dose. Model selection aims to minimize the expected number of times that a dose is incorrectly classified as safe or unsafe while sample size selection targets an expected number of incorrectly classified doses. Randomization is 1:1 for the initial cohort, and for subsequent cohorts is chosen to maximize the lower confidence bound.
    Results: The spike-and-slab model minimizes the expected number of times that a dose is incorrectly classified as safe or unsafe under the most scenarios in the motivating three-dose trial, but all six models exhibit relatively similar performance. A 2:1 randomization ratio for the second and third cohorts maximizes the lower confidence bound when using the spike-and-slab model. With the optimal design, on average, 70 individuals will ensure 1 incorrectly classified dose in 6 opportunities.
    Conclusion: We recommend that the motivating trial use the spike-and-slab model with a 1:1 randomization ratio for the initial cohort and 2:1 randomization ratio for subsequent cohorts; however, the simpler fixed effects approaches performed similarly well.
    MeSH term(s) Humans ; Nitroprusside/therapeutic use ; Bayes Theorem ; Cardiopulmonary Resuscitation ; Research Design ; Lactates
    Chemical Substances Nitroprusside (169D1260KM) ; Lactates
    Language English
    Publishing date 2023-07-24
    Publishing country England
    Document type Randomized Controlled Trial ; Clinical Trial, Phase I ; Journal Article
    ZDB-ID 2138796-5
    ISSN 1740-7753 ; 1740-7745
    ISSN (online) 1740-7753
    ISSN 1740-7745
    DOI 10.1177/17407745231188443
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    Zs.A 5831: Show issues Location:
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  3. Article ; Online: Cerebral hemodynamic effects of head-up CPR in a porcine model.

    Jaeger, Deborah / Kosmopoulos, Marinos / Voicu, Sebastian / Kalra, Rajat / Gaisendrees, Christopher / Schlartenberger, Georg / Bartos, Jason A / Yannopoulos, Demetri

    Resuscitation

    2023  Volume 193, Page(s) 110039

    Abstract: Aim: To assess the hemodynamic effects of head elevation on cerebral perfusion during cardiopulmonary resuscitation (CPR) in a porcine model of cardiac arrest.: Methods: VF was induced in eight 65 kg pigs that were treated with CPR after five minutes ...

    Abstract Aim: To assess the hemodynamic effects of head elevation on cerebral perfusion during cardiopulmonary resuscitation (CPR) in a porcine model of cardiac arrest.
    Methods: VF was induced in eight 65 kg pigs that were treated with CPR after five minutes of no flow. Mean arterial pressure (MAP) was measured at the descending thoracic aorta. Internal carotid artery blood flow (CBF) was measured with an ultrasound probe. Cerebral perfusion pressure (CerPP) was calculated in two ways (CerPP
    Results: MAP and coronary perfusion pressure measurements were similar in both CPR positions (p = 0.36 and p = 0.1, respectively). ICP was significantly lower in the HUP CPR group (14.7 ± 1 mm Hg vs 26.9 ± 1 mm Hg, p < 0.001) as was ICAP (30.1 ± 2 mm Hg vs 42.6 ± 1 mmHg, p < 0.001). The proportional decrease in ICP and ICAP resulted in similar CerPP
    Conclusion: HUP did not affect cerebral perfusion pressure and it significantly decreased internal carotid blood flow.
    MeSH term(s) Animals ; Swine ; Cardiopulmonary Resuscitation/methods ; Heart Arrest/therapy ; Hemodynamics/physiology ; Arterial Pressure ; Cerebrovascular Circulation/physiology
    Language English
    Publishing date 2023-11-05
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 189901-6
    ISSN 1873-1570 ; 0300-9572
    ISSN (online) 1873-1570
    ISSN 0300-9572
    DOI 10.1016/j.resuscitation.2023.110039
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    Zs.A 1048: Show issues Location:
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  4. Article ; Online: Association between cardiopulmonary resuscitation duration and survival after out-of-hospital cardiac arrest according: a first nationwide study in France.

    Jaeger, Deborah / Lafrance, Martin / Canon, Valentine / Kosmopoulos, Marinos / Gaisendrees, Christopher / Debaty, Guillaume / Yannopoulos, Demetri / Hubert, Hervé / Chouihed, Tahar

    Internal and emergency medicine

    2023  Volume 19, Issue 2, Page(s) 547–556

    Abstract: Objective: Determining whether to pursue or terminate resuscitation efforts remains one of the biggest challenges of cardiopulmonary resuscitation (CPR). No ideal cut-off duration has been recommended and the association between CPR duration and ... ...

    Abstract Objective: Determining whether to pursue or terminate resuscitation efforts remains one of the biggest challenges of cardiopulmonary resuscitation (CPR). No ideal cut-off duration has been recommended and the association between CPR duration and survival is still unclear for out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the association between CPR duration and 30-day survival after OHCA with favorable neurological outcomes according to initial rhythm.
    Methods: This was an observational, retrospective analysis of the French national multicentric registry on cardiac arrest, RéAC. The primary endpoint was neurologically intact 30-day survival according to initial rhythm.
    Results: 20,628 patients were included. For non-shockable rhythms, the dynamic probability of 30-day survival with a Cerebral Performance Category (CPC) of 1 or 2 was less than 1% after 25 min of CPR. CPR duration over 10 min was not associated with 30-day survival with CPC of 1 or 2 (adjusted OR: 1.67; CI 95% 0.95-2.94). For shockable rhythms, the dynamic probability of 30-day survival with a CPC score of 1 or 2, was less than 1% after 54 min of CPR. CPR duration of 21-25 min was still associated with 30-day survival and 30-day survival with a CPC of 1 or 2 (adjusted OR: 2.77; CI 95% 2.16-3.57 and adjusted OR: 1.82; CI 95% 1.06-3.13, respectively).
    Conclusions: Survival decreased rapidly with increasing CPR duration, especially for non-shockable rhythms. Pursuing CPR after 25 min may be futile for patients presenting a non-shockable rhythm. On the other hand, shockable rhythms might benefit from prolonged CPR.
    MeSH term(s) Humans ; Cardiopulmonary Resuscitation ; Retrospective Studies ; Out-of-Hospital Cardiac Arrest/therapy ; Emergency Medical Services ; Registries ; France/epidemiology
    Language English
    Publishing date 2023-10-29
    Publishing country Italy
    Document type Observational Study ; Multicenter Study ; Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-023-03449-8
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    Zs.A 6673: Show issues Location:
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  5. Article ; Online: Pathophysiology of exercise heart rate recovery: a comprehensive analysis.

    Pierpont, Gordon L / Adabag, Selcuk / Yannopoulos, Demetri

    Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

    2013  Volume 18, Issue 2, Page(s) 107–117

    Abstract: Expanded use of exercise heart rate recovery (HRR) has renewed interest in the pathophysiology of heart rate control. This study uses basic physiologic principles to construct a unique model capable of describing the full time course of sympathetic and ... ...

    Abstract Expanded use of exercise heart rate recovery (HRR) has renewed interest in the pathophysiology of heart rate control. This study uses basic physiologic principles to construct a unique model capable of describing the full time course of sympathetic and parasympathetic activity during HRR. The model is tested in a new study of 22 diverse subjects undergoing both maximal and submaximal treadmill exercise. Based on this analysis, prolongation of HRR involves changes within the sinus node, changes in sympathetic function, in parasympathetic function, and in the central mechanisms regulating autonomic balance. The methods may provide unique insight into alterations in autonomic control in health and disease.
    MeSH term(s) Autonomic Nervous System/physiopathology ; Exercise ; Exercise Test ; Heart Rate ; Humans ; Recovery of Function
    Language English
    Publishing date 2013-01-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1325530-7
    ISSN 1542-474X ; 1082-720X
    ISSN (online) 1542-474X
    ISSN 1082-720X
    DOI 10.1111/anec.12061
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    Zs.A 4953: Show issues Location:
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  6. Article ; Online: ECPR

    Schmitzberger, Florian F / Haas, Nathan L / Coute, Ryan A / Bartos, Jason / Hackmann, Amy / Haft, Jonathan W / Hsu, Cindy H / Hutin, Alice / Lamhaut, Lionel / Marinaro, Jon / Nagao, Ken / Nakashima, Takahiro / Neumar, Robert / Pellegrino, Vincent / Shinar, Zack / Whitmore, Sage P / Yannopoulos, Demetri / Peterson, William J

    Resuscitation

    2022  Volume 179, Page(s) 214–220

    Abstract: Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering from refractory out-of-hospital cardiac arrest (OHCA), though limited data exist regarding the best practices for ... ...

    Abstract Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering from refractory out-of-hospital cardiac arrest (OHCA), though limited data exist regarding the best practices for ECPR initiation after OHCA.
    Methods: We utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. A modified Delphi process builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Consensus was achieved when items reached a high level of agreement, defined as greater than 80% responses for a particular item rated a 4 or 5 on a 5-point Likert scale.
    Results: Snowball sampling generated a panel of 14 content experts, composed of physicians from four continents and five primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 207 items. The panel reached consensus on 101 items meeting final criteria for inclusion: Prior to Patient Arrival (13 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (18), and Post-Cannulation (26).
    Conclusion: We present a list of items for ECPR initiation following adult nontraumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings may benefit centers currently performing ECPR in quality assurance and serve as a template for new ECPR programs.
    MeSH term(s) Adult ; Cardiopulmonary Resuscitation/methods ; Catheterization ; Consensus ; Extracorporeal Membrane Oxygenation/methods ; Humans ; Out-of-Hospital Cardiac Arrest/therapy ; Retrospective Studies
    Language English
    Publishing date 2022-07-08
    Publishing country Ireland
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 189901-6
    ISSN 1873-1570 ; 0300-9572
    ISSN (online) 1873-1570
    ISSN 0300-9572
    DOI 10.1016/j.resuscitation.2022.07.003
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  7. Article ; Online: SCAI expert consensus statement on out of hospital cardiac arrest.

    Lotfi, Amir / Klein, Lloyd W / Hira, Ravi S / Mallidi, Jaya / Mehran, Roxana / Messenger, John C / Pinto, Duane S / Mooney, Michael R / Rab, Tanveer / Yannopoulos, Demetri / van Diepen, Sean

    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

    2020  Volume 96, Issue 4, Page(s) 844–861

    MeSH term(s) Algorithms ; Cardiac Catheterization/adverse effects ; Cardiac Catheterization/mortality ; Cardiac Catheterization/standards ; Cardiology/standards ; Clinical Decision-Making ; Consensus ; Coronary Angiography/standards ; Decision Support Techniques ; Heart-Assist Devices/standards ; Hemodynamics ; Humans ; Out-of-Hospital Cardiac Arrest/diagnosis ; Out-of-Hospital Cardiac Arrest/mortality ; Out-of-Hospital Cardiac Arrest/physiopathology ; Out-of-Hospital Cardiac Arrest/therapy ; Percutaneous Coronary Intervention/adverse effects ; Percutaneous Coronary Intervention/mortality ; Percutaneous Coronary Intervention/standards ; Predictive Value of Tests ; Risk Factors ; Treatment Outcome
    Language English
    Publishing date 2020-06-20
    Publishing country United States
    Document type Journal Article ; Practice Guideline ; Review
    ZDB-ID 1459995-8
    ISSN 1522-726X ; 1522-1946
    ISSN (online) 1522-726X
    ISSN 1522-1946
    DOI 10.1002/ccd.28990
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