Publications by authors named "Dankiewicz J"
Article Synopsis
- Acute kidney injury (AKI) is a common and serious problem following out-of-hospital cardiac arrest (OHCA), particularly influenced by post-resuscitation cardiogenic shock (CS).
- A study compared two groups of patients—those receiving targeted mild hypercapnia and those receiving targeted normocapnia—to see if higher carbon dioxide tension impacted AKI rates and other outcomes.
- Results showed that approximately 72.1% of patients developed AKI regardless of treatment, with CS significantly increasing the likelihood of AKI, but carbon dioxide levels did not alter this relationship.
Purpose: Hyperoxemia is common in patients resuscitated after out-of-hospital cardiac arrest (OHCA) admitted to the intensive care unit (ICU) and may increase the risk of mortality. However, the effect of hyperoxemia on functional outcome, specifically related to the timing of exposure to hyperoxemia, remains unclear.
Methods: The secondary analysis of the Target Temperature Management 2 (TTM-2) randomized trial.
Article Synopsis
- Neuroimaging using MRI can help assess brain injuries in comatose adults after cardiac arrest, but data on its use is limited.
- In a study involving 1,639 patients from the TAME trial, only 9% underwent MRI, showing key differences in age, time to resuscitation, and lactate levels compared to those who did not.
- Six months later, only 16% of MRI patients had a favorable neurological outcome, highlighting concerns about the effectiveness of MRI in this context.
Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia.
Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.
Article Synopsis
- The study aimed to evaluate physical activity levels six months post-out-of-hospital cardiac arrest (OHCA) and identify risk factors for low activity levels.
- In a follow-up with 807 OHCA survivors across Europe, Australia, and New Zealand, 34% reported low physical activity, while 44% were moderately active and 22% highly active.
- Significant risk factors for low physical activity included obesity, mobility issues, and cognitive impairment.
The management of cardiogenic shock is an ongoing challenge. Despite all efforts and tremendous use of resources, mortality remains high. Whilst reversing the underlying cause, restoring/maintaining organ perfusion and function are cornerstones of management.
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- Airway management is vital in treating out-of-hospital cardiac arrest (OHCA), focusing on whether tracheal intubation (TI) or supraglottic airway devices (SGA) lead to better patient outcomes.
- A secondary analysis of the TTM2 trial included 1702 adult OHCA patients and found that most (71.6%) received TI, while 28.4% were managed with SGA.
- Results indicated that the type of airway management did not significantly affect outcomes like ventilator-free days, neurological status, or mortality rates after 26 days.
Aim: Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA).
Methods: Prospective observational multicentre substudy of the "Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest Trial", also known as the TTM2-trial. Presence or absence of highly malignant EEG patterns and EEG reactivity to external stimuli were prospectively assessed and reported by the trial sites.
Article Synopsis
- The study aimed to use standardized and automated CT assessments to predict outcomes for patients who suffered out-of-hospital cardiac arrest.
- Involving 140 unconscious patients, results showed that while qualitative assessments and various gray-white-matter ratio (GWR) models achieved 100% specificity in predicting poor outcomes, sensitivity rates varied, with automated GWR proving robust.
- The research concluded that these CT assessment methods could reliably indicate poor functional outcomes, and automated GWR could enhance accessibility for medical centers handling cardiac arrest cases.
Article Synopsis
- The study evaluated the effectiveness of highly malignant EEG patterns (HMEP) in predicting poor neurological outcomes after cardiac arrest, following 2021 guidelines from the ERC and ESICM.
- In a multicenter trial involving 845 patients, HMEP showed 50% sensitivity and 93% specificity for poor outcomes, with an increase in specificity to 97% when combined with an unresponsive EEG.
- The findings indicate that while the specificity of these EEG patterns is high, it's less than previously reported, suggesting a need for cautious application in clinical settings due to potential biases affecting results.
Article Synopsis
- International guidelines suggest keeping body temperature below 37.8 °C for unconscious patients after out-of-hospital cardiac arrest (OHCA), but targeting 33 °C may yield better results for patients with a nonshockable rhythm.
- The study aimed to determine if inducing hypothermia at 33 °C leads to higher survival rates and better functional outcomes compared to maintaining normal body temperature (normothermia).
- Data was gathered from two clinical trials involving unconscious OHCA patients with nonshockable rhythms, comparing those treated with hypothermia versus normothermia for a minimum of 24 hours, analyzing various factors influencing outcomes.*
In animal models, early initiation of therapeutic cooling, intra-arrest, or restored circulation has been shown to be neuroprotective shortly after cardiac arrest. We aimed to assess the feasibility and cooling efficacy of transnasal evaporative cooling, initiated as early as possible after hospital arrival in patients randomized to cooling in the TTM2 trial. This study took the form of a single-center (Södersjukhuset, Stockholm) substudy of the TTM2 trial (NCT02908308) comparing target temperature management (TTM) to 33 °C versus normothermia in OHCA.
View Article and Find Full Text PDFBackground And Aims: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores.
Methods: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.
Article Synopsis
- The TTM2 trial found no significant difference in mortality or poor functional outcomes between targeted hypothermia and targeted normothermia 6 months after out-of-hospital cardiac arrest (OHCA).
- A detailed analysis aimed to assess brain dysfunction and cognitive function in survivors, focusing on societal participation after OHCA.
- This study involved 1861 comatose adults across 61 hospitals in 14 countries, with follow-up conducted by masked assessors showing no differences in functional outcomes between the two temperature control methods.
Article Synopsis
- The study aims to investigate serum proteome profiles of unconscious patients after out-of-hospital cardiac arrest to understand the biological effects of hypoxia-ischaemia and temperature management on neurological outcomes.
- Researchers analyzed serum samples at 24, 48, and 72 hours post-cardiac arrest using mass spectrometry to identify protein changes linked to patient outcomes at a six-month follow-up.
- Results showed that out of 78 patients, many had poor neurological outcomes, with specific proteins associated with either poor or good recovery, indicating potential paths for further research and therapy development.
Background: The CREST model is a prediction model, quantitating the risk of circulatory-etiology death (CED) after cardiac arrest based on variables available at hospital admission, and intend to guide the triage of comatose patients without ST-segment-elevation myocardial infarction after successful cardiopulmonary resuscitation. This study assessed performance of the CREST model in the Target Temperature Management (TTM) trial cohort.
Methods: We retrospectively analyzed data from resuscitated out-of-hospital cardiac arrest (OHCA) patients in the TTM-trial.
Article Synopsis
- Guidelines suggest maintaining normal carbon dioxide levels for adults in a coma resuscitated from cardiac arrest, but mild higher levels may help increase brain blood flow and improve outcomes.
- In a study involving 1,700 patients, participants were randomly assigned to either mild hypercapnia or normocapnia for 24 hours and were assessed 6 months later for neurologic recovery.
- Results showed no significant difference in favorable neurological outcomes or mortality between the two groups, indicating that mild hypercapnia did not improve recovery compared to normal levels.
Purpose: Guidelines recommend targeting mean arterial pressure (MAP) > 65 mmHg in patients after cardiac arrest (CA). Recent trials have studied the effects of targeting a higher MAP as compared to a lower MAP after CA. We performed a systematic review and individual patient data meta-analysis to investigate the effects of higher versus lower MAP targets on patient outcome.
View Article and Find Full Text PDFBackground/aim: Signs of hypoxic ischaemic encephalopathy (HIE) on head computed tomography (CT) predicts poor neurological outcome after cardiac arrest. We explore whether levels of brain injury markers in blood could predict the likelihood of HIE on CT.
Methods: Retrospective analysis of CT performed at 24-168 h post cardiac arrest on clinical indication within the Target Temperature Management after out-of-hospital cardiac arrest-trial.
Article Synopsis
- Targeted temperature management (TTM) after cardiac arrest was studied to see if a lower temperature (33 °C) versus normal temperature (normothermia) leads to better outcomes, particularly based on how quickly the target temperature is reached.
- In a post-hoc analysis of the TTM-2 trial involving 1592 patients, there was no significant difference in mortality or functional outcomes between those who achieved hypothermia fastest and those who remained at normothermia.
- The study concluded that the time taken to reach hypothermia does not significantly affect the effectiveness of TTM of 33 °C compared to maintaining normothermia and treating fever.
BACKGROUND: The evidence for temperature control for comatose survivors of cardiac arrest is inconclusive. Controversy exists as to whether the effects of hypothermia differ per the circumstances of the cardiac arrest or patient characteristics. METHODS: An individual patient data meta-analysis of the Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest (TTM) and Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trials was conducted.
View Article and Find Full Text PDFBackground: Cardiac arrest (CA) represents the third leading cause of death worldwide. Among patients resuscitated and admitted to hospital, death and severe neurological sequelae are frequent but difficult to predict. Blood biomarkers offer clinicians the potential to improve prognostication.
View Article and Find Full Text PDFBackground: Randomised clinical trials with a factorial design may assess the effects of multiple interventions in the same population. Factorial trials are carried out under the assumption that the trial interventions have no interactions on outcomes. Here, we present a protocol for a simulation study investigating the consequences of different levels of interactions between the trial interventions on outcomes for the future 2×2×2 factorial designed randomised clinical Sedation, TEmperature, and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial in comatose patients after out-of-hospital cardiac arrest.
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