Publications by authors named "Joachim During"
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
- Selective water uptake by brain cells and brain tissue swelling after cardiac arrest contribute to hypoxic-ischemic encephalopathy, with CT scans used to evaluate this condition over time.
- This study included head CT scans from 115 cardiac arrest patients to analyze regional net water uptake (NWU) and its relationship with neurological outcomes.
- Results showed that a significant NWU (>8%) in certain brain regions was linked to poor neurological outcomes, suggesting that NWU could be a valuable biomarker for patient prognosis after cardiac arrest.
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.
Background: This study investigated the association of two levels of targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) with administered doses of sedative and analgesic drugs, serum concentrations, and the effect on time to awakening.
Methods: This substudy of the TTM2-trial was conducted at three centers in Sweden, with patients randomized to either hypothermia or normothermia. Deep sedation was mandatory during the 40-hour intervention.
Patients admitted to intensive care after cardiac arrest are at risk of circulatory shock and early mortality due to cardiovascular failure. The aim of this study was to evaluate the ability of the veno-arterial pCO difference (∆pCO ; central venous CO - arterial CO ) and lactate to predict early mortality in postcardiac arrest patients. This was a pre-planned prospective observational sub-study of the target temperature management 2 trial.
View Article and Find Full Text PDFArticle Synopsis
- Head CT is a recommended method for predicting outcomes after cardiac arrest, but there is no standardized assessment system for diagnosing hypoxic-ischaemic encephalopathy (HIE).
- The study is part of an international trial (TTM2) aiming to evaluate CT images of patients who are still unconscious 48 hours after cardiac arrest, using a standardized protocol to assess HIE severity and related brain function.
- The outcomes will be measured through functional assessments at six months post-arrest, and findings will help establish reliable criteria for using CT in neuroprognostication after cardiac arrest.
Background: Targeted temperature management at 33 °C (TTM33) has been employed in effort to mitigate brain injury in unconscious survivors of out-of-hospital cardiac arrest (OHCA). Current guidelines recommend prevention of fever, not excluding TTM33. The main objective of this study was to investigate if TTM33 is associated with mortality in patients with vasopressor support on admission after OHCA.
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- Scientists are studying blood markers that can help doctors understand how serious a brain injury is after someone has a cardiac arrest (when the heart stops).
- They are doing tests to find out which blood marker is the best at predicting how well a person will recover after six months.
- The goal is to set clear rules for doctors to follow so they can use these markers in everyday medical care to help patients better.
Article Synopsis
- Hypotension after cardiac arrest can worsen brain damage caused by lack of oxygen, and the effects of circulatory shock during hospital admission on recovery have not been thoroughly explored.
- The study analyzed data from 4,004 adult patients who experienced out-of-hospital cardiac arrest between 2006 and 2017, focusing on the effects of low blood pressure upon admittance.
- Findings revealed that 38% of patients were in circulatory shock upon admission, leading to a significantly lower chance of good neurological recovery, especially in those without preexisting heart conditions.
Background: Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty.
Methods: In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C).
Article Synopsis
- Arginine vasopressin and its marker, copeptin, play significant roles in the prognosis of critically ill patients, especially post-cardiac arrest, affecting factors like plasma volume and cortisol levels.
- The study analyzed 690 patients who survived out-of-hospital cardiac arrest, measuring copeptin at 24, 48, and 72 hours, focusing on its correlation with 30-day survival and cardiovascular deterioration.
- Results showed that higher levels of copeptin at 24 hours were linked to better survival rates and lower risk of cardiovascular issues, implying it could serve as an important marker for assessing post-cardiac arrest severity.
Bedside interpretation of simplified continuous EEG after cardiac arrest.
Acta Anaesthesiol Scand
January 2020
Background: Continuous EEG-monitoring (cEEG) in the ICU is recommended to assess prognosis and detect seizures after cardiac arrest but implementation is often limited by the lack of EEG-technicians and experts. The aim of the study was to assess ICU physicians ability to perform preliminary interpretations of a simplified cEEG in the post cardiac arrest setting.
Methods: Five ICU physicians received training in interpretation of simplified cEEG - total training duration 1 day.
Background: Left ventricular (LV) dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock.
Methods: A prospective, observational, cohort study of 49 patients.
Introduction: The diagnosis of acute lung injury (ALI) may be more robust if more accurate physiological markers can be identified. Extravascular lung water (EVLW) is one possible marker, and it has been shown to correlate with respiratory function and mortality in patients with sepsis. Whether EVLW confers diagnostic value in a general population with shock, as well as which index performs best, is unclear.
View Article and Find Full Text PDFIntroduction: Assessing left ventricular (LV) systolic function in a rapid and reliable way can be challenging in the critically ill patient. The purpose of this study was to evaluate the feasibility and reliability of, as well as the association between, commonly used LV systolic parameters, by using serial transthoracic echocardiography (TTE).
Methods: Fifty patients with shock and mechanical ventilation were included.