Publications by authors named "Corstiaan A Den Uil"
Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study.
Crit Care Med
December 2024
Objectives: This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores.
Design, Setting, And Patients: We conducted a retrospective cohort study (2009-2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals.
Health-related quality of life one year after refractory cardiac arrest treated with conventional or extracorporeal CPR; a secondary analysis of the INCEPTION-trial.
Resusc Plus
September 2024
Article Synopsis
- A study examined health-related quality of life (HRQoL) in patients who survived out-of-hospital cardiac arrest (OHCA) treated with either extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) during the first year post-incident.
- Out of 134 enrolled patients, only 20% survived to hospital discharge, with HRQoL assessed for 25 survivors using the EQ-5D-5L questionnaire, revealing 68% had good HRQoL after one year.
- Although there was no significant statistical difference in HRQoL scores between ECPR and CCPR groups, results suggested that ECPR survivors experienced numerically better outcomes,
Article Synopsis
- Researchers aimed to determine if 24-hour invasive haemodynamic profiling offers better prognostic information than initial assessments for predicting in-hospital death in patients with acute decompensated heart failure cardiogenic shock (ADHF-CS).
- The study included 127 patients, revealing that factors like age and pulmonary elastance (PaE) were strong predictors of mortality; the overall in-hospital death rate was 26.8%.
- Specifically, PaE was the strongest predictor of in-hospital death, with a defined cut-off value, and highlighted the importance of classifying patients based on their haemodynamic measurements for better risk assessment.
Recently, the importance of efficient and effective health care has been recognized, especially during the acute phase of the Coronavirus Disease-2019 (COVID-19) pandemic. Intensive care units (ICUs) have faced an immense workload, with massive numbers of patients being treated in a very short period of time. In general, ICUs are required to deliver high-quality care at all times during the year.
View Article and Find Full Text PDFEligibility of cardiac arrest patients for extracorporeal cardiopulmonary resuscitation and their clinical characteristics: a retrospective two-centre study.
Eur J Emerg Med
April 2024
Background And Importance: Sudden cardiac arrest has a high incidence and often leads to death. A treatment option that might improve the outcomes in refractory cardiac arrest is Extracorporeal Cardiopulmonary Resuscitation (ECPR).
Objectives: This study investigates the number of in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients eligible to ECPR and identifies clinical characteristics that may help to identify which patients benefit the most from ECPR.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) is a major cause of death globally and can lead to varying cardiac rhythms during patient transfer from emergency medical services (EMS) to the emergency department (ED).
- The study aimed to evaluate how often these rhythm changes occur and their potential impact on patient outcomes, focusing on a period from January 2017 to December 2019.
- Findings indicated that 7.8% of patients experienced rhythm changes during transfer, and those patients had significantly lower survival rates upon arrival at the ED compared to those without rhythm changes.
Background: In hospitalized patients with COVID-19, the dosing and timing of corticosteroids vary widely. Low-dose dexamethasone therapy reduces mortality in patients requiring respiratory support, but it remains unclear how to treat patients when this therapy fails. In critically ill patients, high-dose corticosteroids are often administered as salvage late in the disease course, whereas earlier administration may be more beneficial in preventing disease progression.
View Article and Find Full Text PDFIntroduction: In cardiac arrest, cerebral ischemia and reperfusion injury mainly determine the neurological outcome. The aim of this study was to investigate the relation between the course of cerebral oxygenation and regain of consciousness in patients treated with extracorporeal cardiopulmonary resuscitation (ECPR). We hypothesized that rapid cerebral oxygenation increase causes unfavorable outcomes.
View Article and Find Full Text PDFArticle Synopsis
- A high BMI is typically linked to worse outcomes in COVID-19, but this study found it may actually be associated with lower mortality in critically ill patients under 45 years old.
- The analysis included over 15,000 critically ill COVID-19 patients from a national registry, controlling for various factors like age and gender.
- The results suggest that while BMI above 30 kg/m² doesn't impact hospital mortality for patients 45 and older, it may have a protective effect for younger patients, supporting the "obesity paradox."
Article Synopsis
- - Patients aged 70 and older make up a significant part of the COVID-19 ICU population in the Netherlands, with high mortality rates, prompting a study to compare their outcomes with those of similar patients suffering from bacterial and other viral pneumonias.
- - The study analyzed data from over 11,000 patients, finding that those admitted for COVID-19 had ICU and hospital mortality rates of 39.7% and 47.6%, respectively, which are significantly higher than the rates for those admitted for bacterial or other viral pneumonia.
- - Results indicate that even after considering factors like age, health conditions, and ICU capacity, COVID-19 remains a more severe illness for patients aged 70 and older compared to bacterial
Unlabelled: Electrical impedance tomography (EIT) has been shown to be of value in evaluating the distribution of ventilation. In addition, several studies, particularly case reports, have demonstrated the use of EIT in the assessment of lung perfusion. EIT may be a potential diagnostic bedside tool in the diagnosis and follow-up of acute pulmonary embolism.
View Article and Find Full Text PDFSystematic review and meta-analysis comparing low-flow duration of extracorporeal and conventional cardiopulmonary resuscitation.
Interact Cardiovasc Thorac Surg
September 2022
Article Synopsis
- After cardiac arrest, survival outcomes are influenced by the duration of low-flow periods during resuscitation efforts using either extracorporeal cardiopulmonary resuscitation (ECPR) or conventional cardiopulmonary resuscitation (CCPR).
- The study analyzed data from 42 observational studies, concluding that ECPR has a slower decline in survival rates over time compared to CCPR, for both adults and children.
- Overall, despite rapid declines in survival for both ECPR and CCPR, ECPR showed better short-term survival rates in relation to low-flow duration, indicating its effectiveness as a resuscitation method.
Purpose: we evaluated the effects of the shift of a targeted temperature management (TTM) strategy from 33 °C to 36 °C in comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the Intensive Care Unit (ICU). Methods: we performed a retrospective study of all comatose (GCS < 8) OHCA patients treated with TTM from 2010 to 2018 (n = 798) from a single-center academic hospital. We analyzed 90-day mortality, and neurological outcome (CPC score) at ICU discharge and ICU length of stay, as primary and secondary outcomes, respectively.
View Article and Find Full Text PDFObjective: Current data on intensive care unit (ICU) admissions in patients with adult congenital heart disease (ACHD) are limited and focus on admissions after elective cardiac surgery. This study describes non-elective ICU admissions in patients with ACHD.
Methods: A retrospective matched cohort study was performed from January 2000 until December 2015 in a tertiary care centre ICU (there was no cardiac care unit).
Article Synopsis
- The study aims to determine if early coronary angiography (within 2 hours) after out-of-hospital cardiac arrest (OHCA) leads to a higher incidence of acute kidney injury (AKI) compared to delayed angiography.
- It analyzed data from 2,375 patients and found that 18.5% of those undergoing early angiography developed AKI versus 24.1% in the delayed group, suggesting that early angiography may not increase AKI risk (non-inferior results).
- Factors influencing AKI development included the timing of return of spontaneous circulation and use of certain heart medications, highlighting the importance of patient treatment history in AKI risk assessment.
Article Synopsis
- The study investigates the feasibility of measuring skin mitochondrial partial oxygen pressure (mitoPO) during cardiac arrest and extracorporeal cardiopulmonary resuscitation (ECPR) in pigs.
- It found that continuous mitoPO measurements are possible, with results showing a delay in initial mitoPO spikes after ECPR initiation, and that mitoPO did not consistently correlate with mean arterial pressure (MAP).
- The findings suggest the need for alternative metrics beyond MAP to better assess tissue perfusion quality during cardiac arrest and ECPR, with one pig surviving the experimental conditions.
Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion.
View Article and Find Full Text PDFArticle Synopsis
- It found that after accounting for various cardiac arrest factors, there was no significant difference in 90-day mortality rates or rehabilitation outcomes between women and men.
- The results suggest that the previously observed higher mortality risk for women may be related to other cardiac arrest characteristics rather than inherent sex differences.
Article Synopsis
- High-dose intravenous vitamin C may help reduce harmful reactive oxygen species and improve organ function in patients who have experienced cardiac arrest.
- The study is a double-blind, randomized controlled trial involving 270 participants, who will receive either a placebo, a low dose (3 g), or a high dose (10 g) of vitamin C for 96 hours.
- The main goal is to assess organ failure through the R-SOFA score, and secondary outcomes include neurological health, mortality rates, and various measures of organ performance during recovery.
Background: This study aimed to assess the prevalence of chest wall injuries due to cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA) and to compare in-hospital outcomes in patients with versus without chest wall injuries.
Methods: A retrospective cohort study of all intensive care unit (ICU)-admitted patients who underwent cardiopulmonary resuscitation for OHCA between January 1, 2007, and December 2019 was performed. The primary outcome was the occurrence of chest wall injuries, as diagnosed on chest computed tomography.
Article Synopsis
- Endomyocardial biopsy (EMB) is critical for diagnosing new-onset acute heart failure (new-AHF) when noninvasive tests are not feasible, but safety data for patients on veno-arterial ECMO (VA-ECMO) is limited.
- A study comparing patients undergoing EMB on VA-ECMO with those not on it found that major complications occurred in 8.3% of procedures, significantly higher in the VA-ECMO group at 26.1%.
- Despite the risks, EMB provided a histopathologic diagnosis for 78.3% of patients on VA-ECMO, primarily identifying myocarditis, highlighting the need for improved procedural safety while exploring underlying causes of new-A