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Drumheller BC, Tam J, Schatz KW, Doshi AA. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) and ultrasound-guided left stellate ganglion block to rescue out of hospital cardiac arrest due to refractory ventricular fibrillation: A case report. Resusc Plus 2024; 17:100524. [PMID: 38162991 PMCID: PMC10755478 DOI: 10.1016/j.resplu.2023.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Out of hospital cardiac arrest from shockable rhythms that is refractory to standard treatment is a unique challenge. Such patients can achieve neurological recovery even with long low-flow times if perfusion can somehow be restored to the heart and brain. Extracorporeal cardiopulmonary resuscitation is an effective treatment for refractory cardiac arrest if applied early and accurately, but often cannot be directly implemented by frontline providers and has strict inclusion/exclusion criteria. We present the case of a novel treatment strategy for out of hospital cardiac arrest due to refractory ventricular fibrillation utilizing Resuscitative Endovascular Balloon Occlusion of the Aorta-assisted cardiopulmonary resuscitation and intra-arrest left stellate ganglion blockade to achieve return of spontaneous circulation and eventual good neurological outcome after 101 minutes of downtime.
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Affiliation(s)
- Byron C. Drumheller
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan Tam
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kimberly W. Schatz
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ankur A. Doshi
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Deng JJ, Zhang CL, Liu DW, Huang T, Xu J, Liu QY, Zhang YN. Treatment of stellate ganglion block in diseases: Its role and application prospect. World J Clin Cases 2023; 11:2160-2167. [PMID: 37122525 PMCID: PMC10131013 DOI: 10.12998/wjcc.v11.i10.2160] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
The stellate ganglion (SG), as a type of sympathetic ganglion, consists of the sixth and seventh cervical vertebrae and the first thoracic sympathetic ganglia. SG block (SGB) is a minimally invasive injection that aims to inject low-concentration local anesthetics to induce a broad sympathetic blocking effect near the SG. There have been no changes and progress in the clinical application of SGB since the 1830s due to several potential risks, including hematoma from blood vessel injury, hoarseness from recurrent laryngeal nerve injury, and cardiopulmonary arrest. The feasibility and safety of SGB have greatly improved since the appearance of ultrasound-guided SGB. In recent years, SGB has been widely applied in the field of non-anesthesiology sedation, with significant therapeutic effects on pain, immunological diseases, somnipathy, psychological disorders, arrhythmias, and endocrine diseases. The present study reviews the present application of SGB in clinical practice.
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Affiliation(s)
- Jing-Jing Deng
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Cai-Ling Zhang
- Department of Anesthesiology, Meizhou Hospital of Traditional Chinese Medicine, Meizhou 514700, Guangdong Province, China
| | - Dian-Wen Liu
- Department of Anesthesiology, Shangqiu Maternal and Children Health Care Hospital, Shangqiu 476000, Henan Province, China
| | - Tao Huang
- Department of Anesthesiology, Fengshun Hospital of Traditional Chinese Medicine, Meizhou 514700, Guangdong Province, China
| | - Jian Xu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Qing-Yan Liu
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
| | - Yue-Nong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University Yuedong Hospital, Meizhou 514700, Guangdong Province, China
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Wang Y, Liu H, Zhan F. Effects of Natural Borneol on Germ Tube Formation and Preformed Biofilm Activity in Candida albicans. Nat Prod Commun 2022. [DOI: 10.1177/1934578x221129128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Candida albicans infection mainly occurs in patients with suppressed immune function and is the main pathogen of nosocomial infections. The use of natural products aimed at controlling fungal diseases is considered an interesting alternative to synthetic fungicides due to their lower adverse reactions and the lower cost of plant preparations compared to modern conventional pharmaceuticals. Natural borneol has a long history of treating ulcers and local infections in traditional Chinese medicine. In this study, we present an analysis of the in vitro effects of natural borneol on planktonic cells of C albicans in the liquid and vapor phases. We also investigated the effects of natural borneol on germ tube formation and mature biofilm activity of C albicans. We found that vapor-phase borneol (minimum inhibitory concentration [MIC] 0.4 mg/cm3) inhibited C albicans more effectively than in the liquid phase (MIC 2 mg/mL). The C albicans germ tube decreased by 99% to 60% at sub-MICs of 0.5 to 0.125 mg/mL. The inhibitory effects of 0.25, 0.5, 1, 2, and 4 mg/mL borneol on the biofilm activity were 33.7%, 48.6%, 49.9%, 52.9%, and 58.2%, respectively. Natural borneol may have potential in the treatment and prevention of C albicans infections.
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Affiliation(s)
- Yazhou Wang
- Department of Clinical Laboratory, Changzhou Cancer Hospital, Changzhou, China
| | - Huiling Liu
- Department of Clinical Laboratory, Changzhou Cancer Hospital, Changzhou, China
| | - Feng Zhan
- Department of Clinical Laboratory, Changzhou Cancer Hospital, Changzhou, China
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Bedside Point-of-Care Ultrasonography in Anesthesiology and Pain Management: A New Trend in Iran: A Narrative Review. Neuromodulation 2022. [DOI: 10.5812/ipmn-123157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
: Since the emergence of ultrasonography, many specialists, including anesthesiologists, have become interested in its practices. Technological innovations in portable ultrasonography devices and their quality enable anesthesiologists to use ultrasonography in various medical conditions and improve their diagnostic and therapeutic interventions. This article clarifies the significance of point-of-care ultra-sonography (POCUS) and highlights the challenges ahead. POCUS can help regional anesthesiologists and pain physicians in vascular access, airway management, focused cardiac ultra-sound (FoCUS), lung ultrasound, gastric ultrasound, focus assessment with sonography in trauma (FAST), regional and neuraxial nerve blocks, and acute and chronic pain management. However, similar to any new clinical method, there are challenges to POCUS, especially in developing countries like Iran. These challenges include the need for more budget allocation for medical equipment and portable devices, developing a comprehensive local curriculum and transparent framework to train residents and postgraduates, creating and/or revising university policies, clinical coordination with healthcare networks, and collaboration with healthcare providers. This article expresses the importance and effectiveness of point-of-care sonography performed by anesthesiologists and pain specialists in Iran and highlights the challenges ahead.
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Scaturo N, Shomo E, Frank M. Current and investigational therapies for the treatment of refractory ventricular fibrillation. Am J Health Syst Pharm 2022; 79:935-943. [PMID: 35020803 DOI: 10.1093/ajhp/zxac011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Esmolol, dual sequential defibrillation, vector change defibrillation, and left stellate ganglion block are presented and reviewed for the treatment of refractory ventricular fibrillation. SUMMARY Although no formal definition has been established for refractory ventricular fibrillation, the literature describes it as a pulseless ventricular arrhythmia that persists despite 3 standard defibrillation attempts, administration of amiodarone 300 mg intravenously, and provision of three 1-mg intravenous doses of epinephrine. Evolving literature surrounding resuscitation in this particular subset of cardiac arrest challenges the efficacy of traditional therapies, such as epinephrine, and suggests that other treatment modalities may improve outcomes. Case reports, case series, and small retrospective studies have pointed to benefit when utilizing a variety of therapies, namely, esmolol, dual sequential defibrillation, vector change defibrillation, or left stellate ganglion block, in patients with refractory ventricular fibrillation arrest. CONCLUSION A mounting, although limited, body of evidence suggests that esmolol, dual sequential defibrillation, vector change defibrillation, or left stellate ganglion block may be effective at terminating refractory ventricular fibrillation and improving patient outcomes. Further evidence is required before these therapies can be adopted as standard practice; however, as key members of the code response team, it is imperative for pharmacists to be familiar with the supporting evidence, safety considerations, and logistical challenges of utilizing these treatments during arrest.
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Affiliation(s)
- Nicholas Scaturo
- Department of Pharmacy, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Eileen Shomo
- Department of Pharmacy, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Marshall Frank
- Emergency Medicine Program, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, andSarasota County Fire Department, Sarasota, FL, USA
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Mohd Y, Kumar A, Sheikh I, Fatima A, Bhoi S, Jamshed N, Aggarwal P. Calming the storm - Stellate ganglion block in refractory ventricular arrhythmia in the emergency department. Am J Emerg Med 2021; 45:685.e5-685.e8. [PMID: 33436317 DOI: 10.1016/j.ajem.2020.12.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yaseen Mohd
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Irtiqa Sheikh
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Afroz Fatima
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Senaratne JM, Sandhu R, Barnett CF, Grunau B, Wong GC, van Diepen S. Approach to Ventricular Arrhythmias in the Intensive Care Unit. J Intensive Care Med 2020; 36:731-748. [PMID: 32705919 DOI: 10.1177/0885066620912701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arrhythmias are commonly encountered in the intensive care unit as a primary admitting diagnosis or secondary to an acute illness. Appropriate identification and treatment of ventricular arrhythmias in this setting are particularly important to reduce morbidity and mortality. This review highlights the epidemiology, mechanisms, electrocardiographic features, and treatment of ventricular arrhythmias.
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Affiliation(s)
- Janek M Senaratne
- Division of Cardiology, 3158University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Roopinder Sandhu
- Division of Cardiology, 3158University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean van Diepen
- Division of Cardiology, 3158University of Alberta Hospital, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
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