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The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia. His respiratory condition stabilized after emergent tracheostomy. Laryngomalacia should be considered even in adult cases when signs of upper airway obstruction manifest after extubation., Author(s): Jun Takeshita [sup.1] , Kei Nishiyama [sup.1] , Masashi Fujii [sup.2] , Hiroyuki Tanaka [sup.1] , Satoru Beppu [sup.1] , Nozomu Sasahashi [sup.1] , Nobuaki Shime [sup.3] Author Affiliations: [...]

The study aims to determine whether the incidence of cardiac arrest and outcome vary depending on geographical locations. The results indicate that there are significant and important regional differences in the incidence of cardiac arrest and outcomes.

A study attempting to establish the relationship between repolarization and sudden cardiac arrest is conducted. Results indicate an increase in early repolarization among patients with a history of idiopathic ventricular fibrillation.

The causes of sudden cardiovascular death in the young athletic population in the Veneto region of Italy and the changes in incidence rates after introduction of systematic preparticipation screening are analyzed. It is observed that the incidence of sudden vascular death in young athletes has significantly reduced since the implementation of the screening, as it is effective in identifying athletes with hypertrophic cardiomyopathy and in providing some protection against the risk of sudden death.

The incidence of ventricular fibrillation or tachycardia among children is determined, while also examining whether the outcome is better for initial than for subsequent ventricular fibrillation or tachycardia. Results demonstrate that in pediatric patients with in-hospital cardiac arrests, survival outcomes were highest among patients in whom ventricular fibrillation or tachycardia was present initially than among those in whom it developed subsequently.

Postischemic myocardial contractile dysfunction is in part mediated by the burst of reactive oxygen species (ROS), which occurs with the reintroduction of oxygen. We hypothesized that tissue oxygen tension modulates this ROS burst at reperfusion. After 20 min of global ischemia, isolated rat hearts were reperfused with temperature-controlled (37.4[degrees]C) Krebs-Henseleit buffer saturated with one of three different [O.sub.2] concentrations (95, 20, or 2%) for the first 5 min of reperfusion and then changed to 95% [O.sub.2]. Additional hearts were loaded with 1) allopurinol (1 mM), a xanthine oxidase inhibitor, 2) diphenyleneiodonium (DPI; 1 [micro]M), an NAD(P)H oxidase inhibitor, or 3) Tiron (10 mM), a superoxide scavenger, and were then reperfused with either 95 or 2% [O.sub.2] for the first 5 min. ROS production and tissue oxygen tension were quantitated using electron paramagnetic resonance spectroscopy. Tissue oxygen tension was significantly higher in the 95% [O.sub.2] group. However, the largest radical burst occurred in the 2% [O.sub.2] reperfusion group (P < 0.001). Recovery of left ventricular (LV) contractile function and aconitase activity during reperfusion were inversely related to the burst of radical production and were significantly higher in hearts initially reperfused with 95% [O.sub.2] (P < 0.001). Allopurinol, DPI, and Tiron reduced the burst of radical formation in the 2% [O.sub.2] reperfusion groups (P < 0.05). Hypoxic reperfusion generates an increased ROS burst originating from multiple pathways. Recovery of LV function during reperfusion is inversely related to this oxygen radical burst, highlighting the importance of myocardial oxygen tension during initial reperfusion. reactive oxygen species; contractile function; cardiac arrest

Pigs with viable chronically dysfunctional myocardium and ischemic cardiomyopathy are at high risk of sudden cardiac death (SCD). We sought to identify the arrhythmic mechanism of SCD, the relation to changes in left ventricular (LV) function, and inducibility of malignant arrhythmias before SCD. Juvenile pigs (n = 72) were instrumented with chronic stenoses on proximal left anterior descending and circumflex arteries. Survival was only 29% 3 mo after instrumentation, and all deaths were sudden and without prodromal symptoms of heart failure. Triphenyltetrazolium chloride staining demonstrated necrosis in only nine animals averaging 2.3 [+ or -] 0.9% of the LV, with no difference between SCD animals and survivors. Implantable loop recorders (n = 13) documented both ventricular fibrillation (n = 6) and bradyasystole (n = 2) as the arrhythmic mechanism of death. Although regional and global function were depressed [anteroseptal wall thickening 1.8 [+ or -] 0.2 vs. 4.2 [+ or -] 0.2 mm in Sham animals (P < 0.001); fractional shortening 21 [+ or -] 2 vs. 31 [+ or -] 1% in Sham animals (P < 0.01)], there were no differences between SCD animals and survivors. LV mass increased in animals with ischemic cardiomyopathy and was greater in animals with SCD (4.0 [+ or -] 0.2 vs. 3.1 [+ or -] 0.1 g/kg in survivors; P < 0.001). Serial programmed ventricular stimulation failed to induce any sustained arrhythmias. We conclude that pigs with viable dysfunctional myocardium and globally reduced LV function have a high rate of SCD with a spectrum of arrhythmias similar to patients with ischemic cardiomyopathy. The risk is independent of necrosis but appears to increase with LV hypertrophy. Like patients with ischemic cardiomyopathy, programmed stimulation is insensitive to predict SCD when viable dysfunctional myocardium is the pathological substrate. hibernating myocardium; arrhythmias

Sudden Cardiac arrest is primarily a problem in patients outside of the hospital; in fact, approximately 80 percent of cases of sudden death from cardiac causes occur at home. Studies confirm the importance of early access to defibrillation for improved survival in out-of-hospital cardiac arrest.

Emotional stress may bring on sudden cardiac death in people predisposed to atherosclerotic cardiovascular disease. Researchers examined coroner records at the time of the Northridge earthquake that struck Los Angeles on January 17, 1994. The death rate from cardiac arrest rose from an average of 5 per day the week before the earthquake to 24 deaths on January 17, 1994. Mortality rates fell sharply to 3 per day during the six days after the earthquake. On the day of the disaster, coroner records indicated 51 of 101 deaths had occurred as a result of underlying heart disease. Twenty-nine people died from trauma. Age and sex characteristics were similar to those of other groups of people who died during 1991, 1992, and 1993. Since only five deaths from cardiac arrest could be expected to occur on the day of the earthquake, the additional 19 deaths can be attributed directly to the earthquake.

Iatrogenic illness is any disorder that results from medical treatment administered by a physician. Implicit in the notion of iatrogenic illness is the preventability of the disorder. A particularly catastrophic form of iatrogenic disorder is cardiac arrest, in which the heart stops supplying blood to body, and (in the absence of immediate reversal of the condition) death ensues. To characterize the conditions and patient population involved in iatrogenic cardiac arrests, a study was carried out in which the records of 203 cases of cardiac arrest were reviewed. All the arrests occurred during 1981 at a teaching hospital. Of the 203, 28 arrests (14 percent) resulted from errors in the use of medication, complications from procedures, and inadequate monitoring of fluid balance, electrocardiograms and other clinical symptoms. Seventeen of the 28 patients (61 percent) died. When the patient characteristics of the 28 cases of iatrogenic arrest were compared with the 175 noniatrogenic cases, no major demographic differences were seen. Patients with iatrogenic arrest were less likely to have suffered a heart attack or to be in cardiac shock at the time of cardiac arrest, but were more likely to survive the episode and to have been taking digoxin than noniatrogenic cases. Iatrogenic cardiac arrest was most often caused either by adverse response to medication (44 percent) or less-than-optimal response to clinical symptoms on the part of physicians (28 percent). An objective review of the circumstances surrounding each incident suggests that 18 of the 28 cases of iatrogenic cardiac arrest (9 percent of the total cases) could have been prevented by improved care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sudden cardiac death (SCD) kills over 350,000 Americans each year, making it the most common cause of death among adult men under age 64, and a frequent cause of death among men and women of all ages. In most cases, an abnormal rhythm (arrhythmia) of the ventricles is the cause of out-of-hospital death, unrelated to acute myocardial infarction (heart attack). Although patients may survive long enough to reach the hospital, only 15 percent to 30 percent survive to leave the hospital. One study showed that half of cardiac arrest victims who were discharged from the hospital were alive two years later, and 40 percent were alive four years later. The first six months after discharge were the most dangerous. Survival is more likely when SCD is caused by ventricular fibrillation (rapid, disorganized heartbeat); in these cases, the time between collapse and the first defibrillation attempt is the most important determinant of survival. Heart conditions associated with SCD among various age groups are discussed. The role of electrophysiological testing, antiarrhythmic drug testing, and electrophysiologically guided drug therapy are outlined, as well as surgical procedures such as angioplasty (insertion of a balloon into an artery to compress fatty deposits) and coronary artery bypass. The use of an automatic implantable cardioverter-defibrillator (AICD system) is recommended for those patients who have suffered cardiac arrest, and whose arrhythmia does not respond to drug therapy. At most experienced centers, death immediately after surgical implant of an AICD happens about once in 33 surgeries, and minor complications occur in 10 percent to 20 percent. Given the high risk of death from SCD, the best solution is prevention through risk factor modification, but short term solutions also include better resuscitation techniques and prevention of recurrences. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sudden cardiac death during exercise is of concern to a large number of sports-minded people because cardiovascular disease is so prevalent in this country. Common causes of sudden cardiac death among athletes include atherosclerosis (plaque build-up in the arteries) in persons over 35 years old, and hypertrophic cardiomyopathy (enlarged heart with disease to the myocardium, middle layer of the walls of the heart), which is more common among younger individuals. A retrospective study of cases of exercise and non-exercise-related sudden cardiac deaths reported in the state of Maryland between 1981 and 1988 was performed. Subjects were between the ages of 14 and 40 years. The medical conditions most often associated with sudden death during exercise were examined. There were 656 non-exercise and 34 exercise-related deaths. In the exercise-related group, over 90 percent were men (31 of 34) and the average age was 26 years. Causes of death in this group were attributed to atherosclerosis (nine cases), hypertrophic cardiomyopathy (eight cases), malformed coronary arteries (four cases), ventricular hypertrophy (three cases), myocarditis (two cases), one case each of arrhythmogenic right ventricle and Kawasaki disease, and six unexplained cases. In the non-exercise-related group, over 75 percent were men (501 of 656) and the average age was 32 years. Severe atherosclerosis was more frequent in total non-exercise-related deaths (307 of 656), and hypertrophic cardiomyopathy was the cause of more exercise-related deaths (8 of 34). These results suggest that patients with hypertrophic cardiomyopathy have an increased risk of suffering sudden cardiac death during exercise. (Consumer Summary produced by Reliance Medical Information, Inc.)

Early repolarization is an ailment, which can be normally found among young adults. Cardiac refibrillation as a mode of treatment for early repolarization is evaluated.