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INTRODUCTION: Cardiopulmonary resuscitation (CPR)-related injuries have not been assessed since the 2015 Resuscitation Guidelines were established. AIM: To describe the incidence and severity of CPR-related injuries, and to evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on the objective assessment of injuries. METHODS: This multicenter, retrospective study analyzed autopsy reports of patients who underwent CPR. The most severe injuries were objectively assessed using the Abbreviated Injury Scale (AIS) and all injuries were summarized according to the New Injury Severity Score (NISS). RESULTS: Among 628 autopsy reports analyzed, patient characteristics and case details were distributed as follows: male sex, 71.1%; median age, 67 years; out-of-hospital cardiac arrest, 89.2%; bystander CPR, 56.8%. CPR-related injuries included: rib(s) 94.6%; lung(s), 9.9%; sternum, 62.4%; liver, 2.5%; and spleen, 1.8%. The incidence of bystander-provided CPR and severity of injury were similar to CPR provided only by professionals. There were no difference between mechanical and manual compressions. Females were older (p = 0.0001) and, although the frequency of their injuries was similar to males, they were significantly more severe (p = 0.01). Patients with life-threatening injury exhibited a baseline profile similar to those without injury . The median score (according to AIS) of the most severe injury was 3 and the median of summary of injuries was 13 according to the NISS-low risk of fatal injury. CONCLUSION: CPR-related injuries occurred frequently, although those that were life-threatening accounted for only 3% of cases. There were no differences between patients who were resuscitated by bystander(s) or by professionals and no differences between mechanical chest devices or manual resuscitation. Compared with a study based on the 2010 guidelines, similar injuries were found, but with more rib fractures, less visceral organ damage, and fewer life-threatening injuries.

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INTRODUCTION: AIM:: To compare injuries after cardiopulmonary resuscitation (CPR) caused by manual or mechanical chest compressions in resuscitated patients with non-traumatic cardiac arrest. METHODS: This retrospective, multicenter study was based on autopsy reports of patients who died after CPR; individuals with a traumatic cause(s) of cardiac arrest were excluded. Patients were divided into two CPR groups: mechanical and manual. The Abbreviated Injury Scale was used to objectively evaluate the most serious injuries and the New Injury Scale Score was used to summarize all injuries. RESULTS: Of 704 patients, data from 630 individuals were analyzed after exclusion of those with trauma-related cardiac arrest. Manual CPR was performed in 559 patients and mechanical in 64 subjects. There were no differences in sex, bystander CPR, or etiology of cardiac arrest between the two groups, however, mechanical CPR was significantly longer (X vs. Y, p = 0.0005) and patients in this group were younger (X vs. Y, p = 0.0067). No differences were found in the incidence of CPR-related injuries between the groups. The median number of the most serious injury (according to Abbreviated Injury Scale) was 3, which was not statistically different; the median number of injuries according to the New Injury Severity Score was 13 in both groups (low probability of fatal injury). Type of injuries were also similar with the exception of pericardial damage that was more prevalent in mechanical CPR group. Only age and bystander CPR were found to be independently associated with the autopsy-documented trauma. CONCLUSION: Our results suggest that mechanical chest compressions do not increase the incidence and severity of CPR-related injury in comparison with manual methods despite significantly longer CPR duration.

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BACKGROUND: Acute phase protein concentrations and serum copper levels in patients in acute phase of myocardial infarction were significantly higher in subjects with heart failure compared to patients with non-complicated course of myocardial infarction. Acute phase protein concentrations correlated with the parameters of the left ventricular systolic function in patients in acute phase of myocardial infarction. The aim of the study was to evaluate the relation of acute phase protein concentrations and serum copper levels with the parameters of left ventricular systolic and diastolic function in patients with chronic heart failure out of the acute phase post myocardial infarction. METHODS AND RESULTS: Authors analysed relation between the acute phase proteins, C-reactive protein, fibrinogen, and copper concentrations and the left ventricular systolic and diastolic function assessed by echocardiography in 38 patients (26 men and 12 women, average age 68 years) with chronic heart failure and advanced left ventricular systolic dysfunction post myocardial infarction with ejection fraction lower or equal to 35%. Serum C-reactive protein concentrations correlated significantly with the left ventricular ejection fraction (r = -0.38, p < 0.05) and with isovolumic relaxation time IRVT (r = -0.51, p < 0.001)--inverse correlation. C-reactive protein concentration correlated with the ratio of the maximal flow velocity of the early transmitral diastolic filling (E vave) and with the maximal transmitral flow velocity during atrial contraction (A wave)--E/A ration (r = 0.43, p < 0.01). C-reactive protein concentration also correlated with the ration of the time velocity integrals of the E wave and the A wave--TVIE/TVIA (r = 0.45, p < 0.01)--positive correlation. Correlation between the fibrinogen and copper concentrations and the left ventricular ejection, or that with parameters of the diastolic left ventricular function were not statistically significant. CONCLUSIONS: Study revealed significant correlation between C-reactive protein concentration and parameters of the left ventricular systolic and diastolic function in patients with chronic heart failure post myocardial infarction. Correlation between copper and fibrinogen levels and parameters of the left ventricular function was not significant.

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AIMS: Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. METHODS: One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). RESULTS: All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). CONCLUSIONS: First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy.

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OBJECTIVE: To assess the pre-hospital delay, i.e. the period which elapses between the onset of pain on the chest and admission to hospital in patients hospitalized on account of acute coronary syndrome. To analyze factors which influence this time interval and obtain thus data for a strategy leading to reduction of the pre-hospital delay. METHOD: Collection of data by means of a questionnaire focused on the time of onset of pain on the chest, time of contact with the health service, time of admission to hospital, type of transport of the patient to hospital, socioeconomic data, manifestations of ischaemic heart disease during the premorbid period and health care provided. Statistical evaluation by the non-paired Mann-Whitney test. RESULTS: Data were assembled from 126 patients admitted to hospital on account of acute coronary syndrome. The median of pre-hospital delay was 5 hours 40 mins., the median of the patient's hesitation 3 hours 44 mins., the median of the transport period was 59 mins. The pre-hospital delay is significantly reduced by transport by the rapid emergency service (p < 0.0001), dispensary care of a cardiologist (p < 0.02) and a previous hospitalization on account of acute myocardial infarction or unstable angina pectoris (p < 0.04). Pre-hospital delay is significantly prolonged in old age pensioners (p < 0.05). On the borderline of signficance is the reduction of pre-hospital delay in patients younger than 80 years (p < 0.06) and patients with higher than elementary education (p = 0.102). CONCLUSION: Prehospital delay in the investigated group is almost three times longer as compared with data from abroad. A most significant part in this delay is played by the long hesitation of patients and transport of the patient to the health institution by other means than the rapid emergency service. In order to provide effective treatment to a larger number of patients with acute coronary syndrome within the shortest time interval it is necessary to inform the population at large on the importance of sudden pain on the chest and the necessity of the quickest possible contact with the rapid emergency service on phone 155. Only then can we expect further improvements of the prognosis of these patients.

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UNLABELLED: The authors examined the serum copper concentrations in a group of 40 patients with chronic heart failure and significant systolic left ventricular dysfunction with an ejection fraction of less than 35%. In 21 patients the examination was made on admission to hospital on account of deterioration of cardiac insufficiency (group A), in 19 patients with stable chronic cardiac failure the examination was made at the out-patient department (group B). Assessment of serum copper concentrations was made by the method of absorption spectrophotometry under standard conditions. Assessment of the ejection fraction of the left ventricle and dimensions of the cardiac compartments was made by two-dimensional echocardiography. The heart rate was assessed from the electrocardiogram at rest. RESULTS: The authors found statistically significantly higher copper concentrations in patients of group A (19.78 +/- 1.67 mumol/l) as compared with group B (14.80 +/- 1.54 mumol/l, p < 0.001). The correlation between copper concentrations, the left ventricular ejection fraction, dimensions of the cardiac compartments and heart rate are not significant. CONCLUSION: Serum copper concentrations in patients with chronic heart failure and significant systolic left ventricular dysfunction are related to the severity of the disease and are higher in patients admitted on account of cardiac insufficiency than in patients with stable cardiac failure.

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The authors assessed serum copper and lipoprotein concentrations in a group of 67 patients hospitalized successively at the cardiological department. During hospitalization they were subjected to selective coronarography with assessment of the angiographic score. In 35 patients the angiographic examination was made during the chronic stage of IHD (group A), in 32 patients it was indicated on account of acute coronary syndrome (group B). The authors found that serum copper concentrations are significantly higher in patients with acute forms of IHD (group B, p < 0.001). Serum copper concentrations do not correlate significantly with lipoprotein concentrations nor with the extent of coronary atheroclerosis (angiographic score).

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INTRODUCTION: Treatment of acute myocardial infarction is undergoing changes. In the treatment of acute myocardial infarction in particular the following proved useful: thrombolysis, administration of anti-aggregating drugs, beta-blockers and inhibitors of angiotensin converting enzyme. An decisive part is played by the interval between the onset of symptoms and the beginning of hospital treatment. OBJECTIVE: To describe treatment of patients hospitalized at intensive care units for acute myocardial infarctions. Investigate differences between faculty and other hospitals. METHOD: The authors investigated by means of questionaires in a prospective study during the first three months in 1996 all patients who were hospitalized on account of acute myocardial infarction. The investigation was implemented in seven intensive care units of faculty hospitals and in nine intensive care units of hospitals and information on diagnosis, pharmacotherapy and results of therapy were assembled. During the first 24 hours of treatment more detailed information was procured. RESULTS: Antiaggregants were used in 88%, nitrates in 77.8%, thrombolytics, beta-blockers and and ACE inhibitors in ca 30% patients. Percutaneous transluminal coronary angioplasty was used in ca 7% patients. CONCLUSIONS: The authors describe treatment of the acute stage of myocardial infarction. In faculty hospitals in 1996 thrombolysis, percutaneous transluminal coronary angioplasty, beta-blockers and nitrates by the i.v. route were used more frequently.

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The anticonvulsant action of three drugs facilitating GABAergic inhibition by different mechanisms (valproate, phenobarbital and progabide) was studied in 229 young rats (12, 18 and 25 days old) with implanted electrodes. Epileptic afterdischarges (ADs) elicited by electrical stimulation of the sensorimotor cortex were used as a model. All three drugs were able to suppress ADs, even the lowest doses used blocked the prolongation seen with repeated stimulations under control conditions. In addition to these general effects, some differences among the three drugs were observed: phenobarbital (10, 20, and 40 mg/kg i.p.) exhibited marked anticonvulsant action in all three age groups whereas valproate (200 and 400 mg/kg i.p.) was somewhat less effective in the youngest rats studied than in the two older groups. Progabide exhibited an effect similar to valproate when a higher dose (150 mg/kg i.p.) was taken into account, but the lower dose (75 mg/kg i.p.) was most efficient in 12 day old rat pups. Our data support the possibility that cortical ADs represent a model of human myoclonic seizures. In addition, they suggest an uneven development of individual components of the GABAergic inhibitory system.

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