Cardiac arrest and death during elective stenting

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No surgery is safe. In every so-called safe surgery, one should take consent about unexpected complications and chances of death on the table or proximal optimization technique (POT) stenting.

A new European registry analysis presented at the Congress of the European Association of Percutaneous Cardiovascular Intervention (EuroPCR) 2019 has identified high rates of unexpected cardiac arrest and death in patients undergoing elective percutaneous coronary intervention (PCI).

An analysis of more than 113,000 elective cases performed at high-volume PCI centers shows that 330 patients arrested during PCI, or one per 344 procedures.

Of these, 162 patients actually died on the table (20%) or during the first 24 hours (29%), corresponding to one death per 702 procedures. Survival was independent of the cause of cardiac arrest. Mortality in these patients is always around 50% if someone arrests on your table.

Patients with a low SYNTAX score or normal ejection fraction typically arrested because of a technical complication, the proportion arresting because of cumulative ischemia rose with increasing SYNTAX score and worsening ejection fraction. Prognosis was worse if the LVEF was less than 35% and the SYNTAX score more than 30; mortality was inversely related to both.

Among the 29 patients who underwent salvage coronary artery bypass graft surgery, mortality was quite high, at 62%.

All patients who were referred for surgery with a coronary perforation died.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Cardiac arrest during elective stenting

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As per a new registry, 2 patients will die per year in centres doing 1500 stentings per year and 4 will have cardiac arrest on the table due to the procedure. The number may be much higher for low volume centres.

(Medscape Excerpts): A European registry has shown high rates of unexpected cardiac arrest and death in patients undergoing elective percutaneous coronary intervention. The analysis of over 113,000 elective cases performed at 11 high-volume PCI centers (> 1500 cases per year) shows that 330 patients arrested during PCI, or one per 344 procedures; of which 162 patients died on the table or during the first 24 hours corresponding to one death per 702 procedures.

Mortality is 50% if someone arrests on the table as per Dr Koen Ameloot Ziekenhuis Oost-Limburg, Genk, Belgium.

More than half (55%) the patients had a SYNTAX 1 score below 20 and 52% had a normal left ventricular ejection fraction.

The cause of cardiac arrest was technical complication (39%) or cumulative ischemia (32%); acute stent thrombosis (7%), no reflow (7%) and miscellaneous (13%).

Technical complications, such as dissection, perforation, bleeding, stroke, and stent loss, occurred in both low- and high-risk patients, whereas cumulative ischemia typically happened in high-risk PCI patients with many coronary manipulations.

Patients with a low SYNTAX score or normal ejection fraction typically arrested because of a technical complication, the proportion arresting because of cumulative ischemia rose with increasing SYNTAX score and worsening ejection fraction. Prognosis was worse if the LVEF was less than 35% and the SYNTAX score more than 30; mortality was inversely related to both.

Among the 29 patients who underwent salvage bypass surgery, mortality was quite high, at 62%. And, “remarkably, all patients who were referred for surgery with a coronary perforation died.

Patients with a SYNTAX score above 30 and an ejection fraction below 35% most often died because of cumulative ischemia on the table.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Hypothermia is a major cause of mortality during winter in India

Health Care, Heart Care Foundation of India, Medicine Comments Off

Avoid hypothermia in this winter by taking certain necessary precautions

New Delhi, 20th January 2019: According to a recent report, about 44 people died in Delhi between 1 January and 6 January, includng a two-year-old child due to the cold weather conditions. Several of these deaths may probably be due to a condition called hypothermia.

Hypothermia is generally defined as having a core body temperature of 95 degrees Fahrenheit or lower and can occur when the outside environment gets too cold or the body’s heat production decreases.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “People can die of hypothermia in the winter season. Imagine a situation when you come across people lying in an area with no clothes early in the morning. One of them is shivering and the other one is not. The one who is shivering indicates that his body is trying to compensate with the low body core temperature. The other one, who is not shivering, may be dead, dying or normal. Recall your naturopathy teaching Sar Thanda, Pet Naram and Paon Garam. If the sole of the feet and the feet are cold and the person is not shivering, this is a medical emergency. On the contrary, if the person is not shivering and the feet are warm, it is not medical emergency. Therefore, hypothermia with no shivering and hyperthermia with no sweating are bad signs.”

An individual may suffer from hypothermia if he or she has been exposed to cool temperatures and shows one or more of the following signs: slowed or slurred speech; sleepiness or confusion; shivering or stiffness in the arms and legs; poor control over body movements; slow reactions, or a weak pulse.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “In hypothermic deaths, a person can be revived even after hours of cardiac arrest. Only once the body temperature is brought back to normal CPR will be effective. That would mean that consciousness gets frozen and does not leave the body when the temperature is below 35°C. This forms the basis for induced hypothermia after death to revive the brain.”

Some tips from HCFI

Here are a few tips to help older people avoid hypothermia.

  • Make sure your home is warm enough. Set the thermostat to at least 68 to 70 degrees.
  • Even mildly cool homes with temperatures from 60 to 65 degrees can lead to hypothermia in older people.

To stay warm at home, wear long underwear under your clothes, along with socks and slippers. Wear several layers of warm loose clothing to help trap warm air between the layers. In India, wear a monkey cap.

  • Use a blanket to keep your legs and shoulders warm and wear a hat or cap indoors.
  • When going outside in the cold, it is important to wear a hat, scarf, and gloves or mittens to prevent loss of body heat through your head and hands. A hat is particularly important because a large portion of body heat can be lost through the head.
  • Check if any prescription or over-the-counter medications you consume can increase your risk for hypothermia.
  • Remember hypothermia with no shivering is a bad sign

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