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Sudden unexpected death in epilepsy and ventricular fibrillation
Abstracts / Resuscitation 96S (2015) 43–157
During the out of hours period, time since last review was significantly extended: mean of 14.4 hours compared with 8 hours during normal operating time. 89% (n = 50) presented in non-shockable rhythms. 51% (n = 28) of CPR episodes considered predictable on the basis of patient background, presentation and physiological trend. 36% (n = 20) were considered potentially preventable, either through optimised management or recognition of futility of CPR. Conclusion: The demographic and clinical picture of patients who underwent CPR in general wards formed by this study is in accordance with national data. The excess occurrence of cardiac arrests out of hours confirms that this period presents additional challenges to optimal care. The predictable and potentially preventable nature of a significant proportion of cases highlights the scope for further systemic improvement.
References 1. Findlay GP, et al. Time to intervene? A review of patients who underwent cardiopulmonary resuscitation as a result of an in-hospital cardiorespiratory arrest. NCEPOD; 2012 http://www.ncepod.org.uk/2012report1/downloads/CAP summary.pdf. 2. Royal College of Physicians. Acute care toolkit 4: 12-hour, 7-day consultant presence on the acute medical unit. www.rcplondon.ac.uk/sites/default/files/ documents/acutecare-toolkit-4.pdf. 3. Clinical quality indicators for acute medical units: society for acute medicine; January 2011.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.340 AP244 Sudden unexpected death in epilepsy and ventricular fibrillation Mariano Veiga 1,∗ , Carolina Santos 2 , Marcos Gouveia 3 , Celeste Dias 3 1
Hospital Central do Funchal, Funchal, Portugal Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal 3 Centro Hospitalar de São João, Porto, Portugal 2
Introduction: Cardiac dysrhythmias, most often premature atrial or ventricular contractions, are occasionally reported during subclavian or internal jugular central venous catheter (CVC) insertion.1 Arrhythmias are usually self-limited and do not require treatment. Human and experimental research has identified cardioautonomic and respiratory dysfunction as a frequent accompaniment in human and animal model events of sudden unexpected death in epilepsy (SUDEP).2 Electrocardiography predictors of sudden cardiac death have been described in people with chronic epilepsy, but their significance for SUDEP remains to be confirmed. Epidemiological risk factors comprise male sex, young age at epilepsy onset, symptomatic cause, longer duration of epilepsy, frequent convulsive seizures and polytherapy.3 No data are currently available on patients with epilepsy who need CVC placement. Case presentation: A 40-year-old male scheduled for epilepsy surgery. A total intravenous anesthesia was performed with remifentanil, propofol and rocuronium. We used the standard ASA monitoring and Bispectral Index (BIS). The induction was uneventful until CVC puncture of right subclavian vein. Soon after the appropriate sized guidewire was passed (12–13 cm), patient developed ventricular fibrillation without prodromes Removal of the guidewire and cardiopulmonary resuscitation were immediately performed, with a recovery of spontaneous circulation after 3 min of advanced life support.
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The surgery was canceled and the patient transferred to the Neurocritical Care Unit for management. In the day after the event, the patient had an appropriate awakening with good neurologic status. Conclusion: Anesthesiologists need to be aware of the association between epilepsy, namely temporal epilepsy and cardiac arrhythmias. It is fundamental to collect a detailed clinical history of the epilepsy, look for cardiovascular co-morbidities and evaluate all risk factors and prior cardiac rhythm findings in order to prevent SUDEP. Novel clinical features may help to define better the individual risk of SUDEP. References 1. Shiroka SA, Akerman P, et al. Incidence of arrhythmia with central venous catheter insertion and exchange. J Parent Enter Nutr 1990;14:152–5. 2. Goldman AM. Mechanisms of sudden unexplained death in epilepsy. Curr Opin Neurol 2015;28:166–74. 3. Surges RL, Sander JW. Sudden unexpected death in epilepsy: mechanisms, prevalence, and prevention. Curr Opin Neurol 2012;25:201–7.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.341 AP245 Preparedness for sudden cardiac arrest at sports arenas; a survey in Turkey Sule Ozbilgin 1,∗ , Bahar Kuvaki 1 , Volkan Hanci 1 , Gamze Ungur 2 , Onur Tutuncu 2 , Merve Koca 2 , Sule Akin 3 , Agah C¸ertug 4 1
Dokuz Eylul University School of Medicine, Anaesthesiology and Reanimation, Izmir, Turkey 2 Dokuz Eylul School of Medicine, Sport Sciences and Technology Department of Coaching Education, Izmir, Turkey 3 Baskent University School of Medicine, Anaesthesiology and Reanimation, Izmir, Turkey 4 Ege University School of Medicine, Anaesthesiology and Reanimation, Izmir, Turkey Introduction: Sudden cardiac arrest is the leading cause of death in football players during exercise (1). Immediate cardiopulmonary resuscitation (CPR) and early defibrillation is life saving (2). In football grounds it is necessary to have a medical action plan (MAP) including automatic external defibrillator (AED), as well as personnel trained in CPR and ready to act during a match as well as during daily training. Method: Football clubs registered at the professional league in Turkey were reached to complete a 12-question survey. The existence of a MAP; presence of an ambulance during a match or workout, the level of emergency medical training of club personnel, the availability of AEDs in the arena; the mean time to reach the nearest hospital were questioned. Results: Thirty-six of the included 58 clubs (62.1%) reported the existence of a written MAP for sports events. While there was a MAP at all Super League teams, this rate fell to 66.7% in 1st league teams, 40% in 2nd and 46.7% in 3rd league teams. The difference was significant (p = 0.005). Medical personnel present during a match commonly are medical doctors of the club (98.3%). An ambulance is always present during super league, first, second and third league matches. During workouts ambulance presence is routine for super league clubs, and for some first league clubs. There is no ambulance presence in other league workouts. 27.6% of the clubs reported having a CPR training program. The mean time to hospital was 5 min. Only 5.2% of stadiums have an AED. Conclusion: By demonstrating the inadequacies concerning MAP, availability of external defibrillators and basic CPR training
During the out of hours period, time since last review was significantly extended: mean of 14.4 hours compared with 8 hours during normal operating time. 89% (n = 50) presented in non-shockable rhythms. 51% (n = 28) of CPR episodes considered predictable on the basis of patient background, presentation and physiological trend. 36% (n = 20) were considered potentially preventable, either through optimised management or recognition of futility of CPR. Conclusion: The demographic and clinical picture of patients who underwent CPR in general wards formed by this study is in accordance with national data. The excess occurrence of cardiac arrests out of hours confirms that this period presents additional challenges to optimal care. The predictable and potentially preventable nature of a significant proportion of cases highlights the scope for further systemic improvement.
References 1. Findlay GP, et al. Time to intervene? A review of patients who underwent cardiopulmonary resuscitation as a result of an in-hospital cardiorespiratory arrest. NCEPOD; 2012 http://www.ncepod.org.uk/2012report1/downloads/CAP summary.pdf. 2. Royal College of Physicians. Acute care toolkit 4: 12-hour, 7-day consultant presence on the acute medical unit. www.rcplondon.ac.uk/sites/default/files/ documents/acutecare-toolkit-4.pdf. 3. Clinical quality indicators for acute medical units: society for acute medicine; January 2011.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.340 AP244 Sudden unexpected death in epilepsy and ventricular fibrillation Mariano Veiga 1,∗ , Carolina Santos 2 , Marcos Gouveia 3 , Celeste Dias 3 1
Hospital Central do Funchal, Funchal, Portugal Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal 3 Centro Hospitalar de São João, Porto, Portugal 2
Introduction: Cardiac dysrhythmias, most often premature atrial or ventricular contractions, are occasionally reported during subclavian or internal jugular central venous catheter (CVC) insertion.1 Arrhythmias are usually self-limited and do not require treatment. Human and experimental research has identified cardioautonomic and respiratory dysfunction as a frequent accompaniment in human and animal model events of sudden unexpected death in epilepsy (SUDEP).2 Electrocardiography predictors of sudden cardiac death have been described in people with chronic epilepsy, but their significance for SUDEP remains to be confirmed. Epidemiological risk factors comprise male sex, young age at epilepsy onset, symptomatic cause, longer duration of epilepsy, frequent convulsive seizures and polytherapy.3 No data are currently available on patients with epilepsy who need CVC placement. Case presentation: A 40-year-old male scheduled for epilepsy surgery. A total intravenous anesthesia was performed with remifentanil, propofol and rocuronium. We used the standard ASA monitoring and Bispectral Index (BIS). The induction was uneventful until CVC puncture of right subclavian vein. Soon after the appropriate sized guidewire was passed (12–13 cm), patient developed ventricular fibrillation without prodromes Removal of the guidewire and cardiopulmonary resuscitation were immediately performed, with a recovery of spontaneous circulation after 3 min of advanced life support.
143
The surgery was canceled and the patient transferred to the Neurocritical Care Unit for management. In the day after the event, the patient had an appropriate awakening with good neurologic status. Conclusion: Anesthesiologists need to be aware of the association between epilepsy, namely temporal epilepsy and cardiac arrhythmias. It is fundamental to collect a detailed clinical history of the epilepsy, look for cardiovascular co-morbidities and evaluate all risk factors and prior cardiac rhythm findings in order to prevent SUDEP. Novel clinical features may help to define better the individual risk of SUDEP. References 1. Shiroka SA, Akerman P, et al. Incidence of arrhythmia with central venous catheter insertion and exchange. J Parent Enter Nutr 1990;14:152–5. 2. Goldman AM. Mechanisms of sudden unexplained death in epilepsy. Curr Opin Neurol 2015;28:166–74. 3. Surges RL, Sander JW. Sudden unexpected death in epilepsy: mechanisms, prevalence, and prevention. Curr Opin Neurol 2012;25:201–7.
http://dx.doi.org/10.1016/j.resuscitation.2015.09.341 AP245 Preparedness for sudden cardiac arrest at sports arenas; a survey in Turkey Sule Ozbilgin 1,∗ , Bahar Kuvaki 1 , Volkan Hanci 1 , Gamze Ungur 2 , Onur Tutuncu 2 , Merve Koca 2 , Sule Akin 3 , Agah C¸ertug 4 1
Dokuz Eylul University School of Medicine, Anaesthesiology and Reanimation, Izmir, Turkey 2 Dokuz Eylul School of Medicine, Sport Sciences and Technology Department of Coaching Education, Izmir, Turkey 3 Baskent University School of Medicine, Anaesthesiology and Reanimation, Izmir, Turkey 4 Ege University School of Medicine, Anaesthesiology and Reanimation, Izmir, Turkey Introduction: Sudden cardiac arrest is the leading cause of death in football players during exercise (1). Immediate cardiopulmonary resuscitation (CPR) and early defibrillation is life saving (2). In football grounds it is necessary to have a medical action plan (MAP) including automatic external defibrillator (AED), as well as personnel trained in CPR and ready to act during a match as well as during daily training. Method: Football clubs registered at the professional league in Turkey were reached to complete a 12-question survey. The existence of a MAP; presence of an ambulance during a match or workout, the level of emergency medical training of club personnel, the availability of AEDs in the arena; the mean time to reach the nearest hospital were questioned. Results: Thirty-six of the included 58 clubs (62.1%) reported the existence of a written MAP for sports events. While there was a MAP at all Super League teams, this rate fell to 66.7% in 1st league teams, 40% in 2nd and 46.7% in 3rd league teams. The difference was significant (p = 0.005). Medical personnel present during a match commonly are medical doctors of the club (98.3%). An ambulance is always present during super league, first, second and third league matches. During workouts ambulance presence is routine for super league clubs, and for some first league clubs. There is no ambulance presence in other league workouts. 27.6% of the clubs reported having a CPR training program. The mean time to hospital was 5 min. Only 5.2% of stadiums have an AED. Conclusion: By demonstrating the inadequacies concerning MAP, availability of external defibrillators and basic CPR training