Publications by authors named "Jana Smalcova"
Background: In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation may increase the survival chance. However, in cases of unsuccessful treatment, extracorporeal cardiopulmonary resuscitation may additionally provide an important source of organ donors. Therefore, we hypothesized that implementing extracorporeal cardiopulmonary resuscitation service into a high-volume cardiac arrest center's routine would increases organ donors' availability.
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- The study evaluated the 1-year outcomes of the ECMO-CS trial, which compared immediate ECMO initiation to an early conservative approach in patients with severe cardiogenic shock.
- Results showed no significant difference in all-cause mortality or other critical outcomes between the two strategies after one year.
- However, there was a suggestion that immediate ECMO could be more beneficial for patients with significantly low mean arterial pressure at baseline, indicating a possible targeted use for this treatment strategy.
Background: It is unclear how invasive resuscitative protocols may impact the time-dependent prognosis of out-of-hospital cardiac arrest (OHCA) resuscitations, or the relationship between intra-arrest transport and outcomes.
Methods: We performed a secondary analysis of the Prague OHCA Study, which randomized refractory OHCAs to "invasive" (intra-arrest transport for possible ECPR initiation) vs. "standard" resuscitation strategies (predominantly performed on-scene).
Article Synopsis
- * Diagnosing NOMI is challenging, and treatment options are limited; its prevalence may depend on how long and how severely the intestines were deprived of blood during the cardiac arrest.
- * NOMI is linked to worse neurological outcomes in cardiac arrest patients, indicating it should be viewed as both a complication and a potential predictor of prognosis in these individuals.
Background: Limited evidence exists for prognostic performance of biomarkers in patients resuscitated from out-of-hospital cardiac arrest (OHCA) with extracorporeal CPR (ECPR). We hypothesized that (1) the time course and (2) prognostic performance of biomarkers might differ between CPR and ECPR in a sub-analysis of Prague-OHCA study.
Methods: Patients received either CPR (n = 164) or ECPR (n = 92).
Both decreased and increased grey-to-white matter attenuation ratio in the putamen and caudate on early head computed tomography differentiate patients with favorable and unfavorable outcomes after prolonged cardiac arrest-secondary analysis of the Prague OHCA study.
Quant Imaging Med Surg
September 2023
Article Synopsis
- - Neurological damage is a major cause of death in cardiac arrest victims, and early brain CT scans are crucial for predicting patient outcomes after out-of-hospital cardiac arrests (OHCA).
- - The study analyzed data from patients who had brain CTs within 36 hours of cardiac arrest, finding that brain edema was only present in those with poor outcomes (CPC 3-5), while specific ratios of grey-to-white matter provided insights into favorable outcomes.
- - Results showed significant distinctions in grey-to-white matter attenuation ratios between favorable (CPC 1-2) and unfavorable outcomes, aiding early neuroprognostication and demonstrating differences between patients treated with conventional CPR versus extracorporeal CPR.
Background: The severity of tissue hypoxia is routinely assessed by serum lactate. We aimed to determine whether early lactate levels predict outcomes in refractory out-of-hospital cardiac arrest (OHCA) treated by conventional and extracorporeal cardiopulmonary resuscitation (ECPR).
Methods: This study is a post-hoc analysis of a randomized Prague OHCA study (NCT01511666) assessing serum lactate levels in refractory OHCA treated by ECPR (the ECPR group) or conventional resuscitation with prehospital achieved return of spontaneous circulation (the ROSC group).
Article Synopsis
- Refractory out-of-hospital cardiac arrest (OHCA) has low survival rates with standard advanced cardiac life support (ACLS), but transporting patients for in-hospital ECPR might yield better outcomes.
- A pooled analysis of two randomized controlled trials, ARREST and PRAGUE-OHCA, was conducted, comparing the effectiveness of in-hospital ECPR versus standard ACLS for patients with OHCA.
- The findings indicated higher survival rates and improved neurological outcomes at both 30 days and 180 days for patients receiving the invasive ECPR approach compared to those who continued with standard ACLS.
Article Synopsis
- The ECMO-CS trial investigated the effectiveness of immediate veno-arterial extracorporeal membrane oxygenation (VA-ECMO) compared to a conservative therapy approach for patients with severe cardiogenic shock.
- The study included 117 patients who were randomly assigned to receive either immediate VA-ECMO or the conservative approach, which allowed for VA-ECMO use if conditions worsened.
- Results showed similar outcomes in terms of death, cardiac arrest, and adverse events between the two groups, suggesting no significant benefit from immediate VA-ECMO.
Background: Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes.
View Article and Find Full Text PDFBackground: The prognosis of refractory out-of-hospital cardiac arrest (OHCA) is generally poor. A recent Prague OHCA study has demonstrated that an invasive approach (including extracorporeal cardiopulmonary resuscitation, ECPR) is a feasible and effective treatment strategy in refractory OHCA. Here we present a post-hoc analysis of the role of initial rhythm on patient outcomes.
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- The study analyzed the medical records of 697 patients who suffered out-of-hospital cardiac arrest (OHCA) between January 2012 and December 2020 to assess coronary angiography (CAG) findings and interventions.
- Among the patients, 23% did not have return of spontaneous circulation (ROSC) upon hospital admission, and those without ROSC were generally younger and experienced longer resuscitation times compared to those with ROSC.
- Although patients without ROSC had higher rates of acute coronary occlusions, PCI was still performed effectively, resulting in a notable but lower 30-day survival rate of 24%, compared to 70% in those with ROSC.
Article Synopsis
- The study investigates the impact of gender on outcomes after out-of-hospital cardiac arrest (OHCA) in patients admitted to a cardiac arrest center, revealing mixed results in previous research.
- A total of 932 patients were analyzed, with women being older, less likely to have a shockable rhythm, and receiving different treatments compared to men, leading to lower survival and neurological outcomes for women.
- Despite initial observations of worse outcomes for women, the logistic regression analysis indicated that gender did not significantly influence survival or neurological outcomes when adjusted for other factors.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) has a low survival rate, and the effectiveness of an early invasive treatment approach compared to standard care is unclear.
- A randomized clinical trial in Prague involved 256 adults with OHCA to assess whether an invasive strategy improves neurologically favorable survival at 180 days.
- The trial was halted early for futility, showing that 31.5% of the invasive group had a good neurologic outcome compared to 22.0% in the standard care group.
Article Synopsis
- Cardiac arrest is a major health issue in developed countries, and extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival chances for those experiencing severe cardiac arrest.
- ECPR and subsequent care face challenges due to high death rates from multi-organ failure, often tied to issues in microcirculation.
- Advanced videomicroscopic technologies are emerging as useful tools for assessing and monitoring microcirculation in patients after cardiac arrest, which is critical for improving treatment outcomes.
Aims: Extracorporeal membrane oxygenation (ECMO) in veno-arterial configuration represents an increasingly used method for circulatory support. ECMO in cardiogenic shock offers rapid improvement of circulatory status and significant increase in tissue perfusion. Current evidence on the use of ECMO in cardiogenic shock remains insufficient.
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- - Cirrhosis of the liver leads to cardiovascular issues, causing both systemic and splanchnic circulation to become hyperdynamic due to arterial vasodilation, which results in symptoms like fluid retention and altered blood volume.
- - These changes can lead to a condition known as cirrhotic cardiomyopathy, characterized by heart dysfunction—including issues with both systolic and diastolic performance and abnormal electrical activity.
- - Early diagnosis of these cardiovascular changes is challenging, and if overlooked, can result in cardiac failure, worsening the already serious implications of cirrhosis, highlighting the need for ongoing research in this area.