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简介：Coronaryangiographyaftercardiacarrestisimportanttoascertainpotentialtreatablecausesofcardiacarrest,salvagemyocardium,andpotentiallyincreaselong-termsurvival.Thecauseofadultout-of-hospitalcardiacarrestistypicallymyocardialischemia.Morethan50%ofsuchresuscitatedindividualswillhaveanacutelyoccludedepicardialcoronaryonemergencycoronaryangiography.ThisincludesthreeinfourwithST-segmentelevationandoneinthreewithoutSTsegmentelevation.Inthelattertheonlyreliablemethodofdetectioniscoronaryangiography.Numerouscohortstudies,nowincludingmorethan8000patients,haveshownanassociationbetweensurvivalandearlycoronaryangiographyand/orpercutaneouscoronaryintervention.Publicreportingofpercutaneouscoronaryintervention30-daymortalityrateshasbeenanimpedimentforextendingthistherapytoallresuscitatedindividualswhoexperiencedout-of-hospitalcardiacarrest,sincecurrentdatabasestodofullyrisk-adjustratesforthissubgroup.Sincereeffortsareunderwaytocorrectthissituation.

简介：Cardiaccatheterizationandpercutaneouscoronaryinterventionplayanimportantroleinthemanagementofcoronaryarterydisease.Althoughthetransfemoralapproachhasbeenthetraditionallydominantmethod,therehasbeenanincreasedutilizationofthetransradialapproach.Multipleobservationalstudiesandrandomizedclinicaltrialshaveshownfewerbleedingcomplications,reducedmorbidityandmortality,improvedqualityoflife,andbettereconomicoutcomeswhenthetransradialapproachisutilizedwhencomparedtothetransfemoralapproach.Despiteitsmanybenefits,utilizationofthisapproachincertaincountriesincludingtheUnitedStateshasbeenlessthanoptimalduetoaloweradoptionratesmostlydrivenbylackoftrainingopportunitiesanddecreasedawarenessofclinicalbenefitsofthetransradialapproach.Inthisreview,thehistory,observationaltrends,efficacy,andtechnicalaspectsoftransradialcardiaccatheterizationandpercutaneouscoronaryinterventionarediscussed.

简介：AbstractIncidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.

简介：BackgroundTherewerefewstudiestoexploretherelationshipbetweenpostoperativemeansystolicbloodpressure(PMSBP)within6haftercardiaccatheterizationandcontrast-inducednephropathy(CIN).MethodsFromJune2010toFebruary2013,299consecutivepatientsundergoingcardiaccatheterizationwererecruited.PatientswereclassifiedintoquartilesbasedonPMSBP(<112,112-120,121-131,and>132mmHg).Baselinedata,CINincidenceandin-hospitaloutcomeswerecomparedbetweenthegroups.LogisticregressionwasusedtoassesstherelationshipbetweenPMSBPandCIN.ResultsCINoccurredin26(8.7%)patients.TheincidenceofCINinPMSBPquartileswere15.3%(11/72),15.1%(11/73),2.4%(2/82)and2.8%(2/72)(P=0.001)respectively.Therewerenosignificantdifferenceinin-hospitaldeath,renalreplacementtherapyandintra-aorticballoonpump(IABP)supportbetweenthegroups(P>0.05).UnivariatelogisticregressionanalysisshowedthatPMSBPwassignificantlyassociatedwithCIN(OR=0.956,95%CI:0.928-0.986,P=0.004).Multivariatelogisticregressionanalysisfoundthatafteradjustingbaselineestimateglomerularfiltrationrate,age>75yearsandacutemyocardialinfarction,PMSBP<120mmHgwasstillanindependentriskfactorforCIN(OR=5.049,95%CI:1.820-14.009,P=0.002).ConclusionsLowerPMSBPwassignificantlyassociatedwithanincreasedriskofCIN.PMSBP<120mmHgwasanindependentriskfactorforCIN.Intensiveblood-pressurecontrolaftercardiaccatheterizationmightincreasetheriskofCIN.

简介：Background:Ketamineisappliedwidelyforsedationduringcardiaccatheterizationinspontaneouslybreathingchildrenwithcongenitalheartdisease(CHD).However,arareandunreportedrespiratorycomplication,transientandreversibleatelectasisoflungs(TRAL),wasidentified.Purpose:ThestudywasperformedtoinvestigateretrospectivelytheprevalenceandclinicalcharacteristicsofTRALafterketaminesedationinpediatriccardiaccatheterization.Methods:Fourthousandfourhundredandseventy-foursickchildrenweresedatedwithketamine,andpediatriccardiaccatheterizationwascarriedoutunderspontaneousbreathing.TRALwasdetectedin33children(17M/16F,agewas2.1±1.7years)byretrospectiveanalysis.Theclinicalandradiographiccharacteristicswererecordedbefore,duringandafterTRAL.Results:Inpediatriccardiaccatheterization,theprevalenceofTRALwas0.74%afterketaminesedation.TRALoccurredin23childrenwithcyanoticCHD,and10withacyanoticCHD.AllTRALshadcommonclinicalandradiographicfeatures:thediffuseopacityofbilaterallungsdevelopedrapidly(identifiedunderX-rayfluoroscopy),associatedwithdecreaseinlungvolume,andthenthedecreaseinSpO2(94.2±9.2%vs.59.4±2.2%,P<0.05),andheartrates(143.5±14.3bpmvs.58.3±9.7bpm,P<0.05)followedquickly.TRALwasrelievedbysupportiveoxygenin32children(23withfacemask,and9withendotrachealintubation),andthedurationofTRALwas1.6±0.5minutes.However,TRALcausedthedeathofonechild.Conclusions:TRALisarareandurgentrespiratorycomplicationafterketaminesedation,andthemechanismisunclear.RapidanddiffuseopacityofbilaterallungsistheearliestsignofTRALinpediatriccardiaccatheterization,andtheimmediatesupportiveoxygeniscrucial.

简介：AbstractIntroduction:Portal venous gas (PVG) is common in necrotizing enterocolitis and occasionally occurs in neonates after umbilical vein catheterization (UVC). Therefore, determining the cause of PVG requires further clinical evaluation in these cases.Case presentation:We report the case of a very-low-birth-weight infant who underwent UVC after birth. PVG was an unexpected finding on ultrasound following catheterization. The UVC was immediately removed and replaced with a peripherally inserted central catheter. The infant’s physical examination was unremarkable. Bedside X-ray revealed neither PVG nor pneumatosis intestinalis, which would indicate the onset of necrotizing enterocolitis. After full evaluation, breastfeeding was started on the same day. The infant did not develop feeding intolerance, necrotizing enterocolitis, or other disorders.Conclusion:PVG occasionally occurs in neonates who undergo UVC and is considered to be caused by exogenous gases. PVG is more easily detected with ultrasound than with X-ray and does not affect early feeding in premature infants.