Circulation. 2007;116:2513
doi: 10.1161/CIRCULATIONAHA.107.187680
(Circulation. 2007;116:2513.)
© 2007 American Heart Association, Inc.
Issue Highlights
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IMPROVED NEUROLOGICAL OUTCOME WITH CONTINUOUS CHEST COMPRESSIONS COMPARED WITH 30:2 COMPRESSIONS-TO-VENTILATIONS CARDIOPULMONARY RESUSCITATION IN A REALISTIC SWINE MODEL OF OUT-OF-HOSPITAL CARDIAC ARREST, by Ewy et al.
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Standard bystander cardiopulmonary resuscitation calls for 2
rapid breaths after 30 chest compressions. Although ventilation
is administered rapidly, the potentially adverse effect of interrupting
chest compressions is unavoidable. Studies in animal models
supported the AHA Guideline recommendation, adopted in 2005,
to decrease ventilations from every 15 compressions to every
30 compressions, but the optimal ratio has yet to be established.
Ewy et al employed a swine model to compare outcomes after cardiac
arrest treated with continuous chest compressions without interposed
ventilation to arrest treated with the standard 30:2 chest compressions
to ventilation before defibrillation. Continuous, uninterrupted
chest compressions increased the number of animals surviving
24 hours with normal neurological function as compared to the
standard 30:2 algorithm. The findings support the importance
of chest compressions, even without administration of ventilation
for bystander cardiopulmonary resuscitation. This realization
should help foster adoption of bystander resuscitation when
administration of ventilation is a deterrent to the bystander.
Further work is warranted to define the appropriate role of
ventilation during resuscitation. See p
2525.
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INCREASED MORTALITY, POSTOPERATIVE MORBIDITY, AND COST AFTER RED BLOOD CELL TRANSFUSION IN PATIENTS HAVING CARDIAC SURGERY, by Murphy et al.
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In this issue of
Circulation, Murphy et al analyze the association
between red blood cell transfusion and outcomes in a large group
of patients having cardiac surgery. The main findings of this
study were as follows: Red blood cell (RBC) transfusion was
strongly associated with infection; RBC transfusion was strongly
associated with a composite ischemic outcome; transfusion was
associated with early complications and was not dependent upon
lowest postoperative hematocrit, and transfusion-related morbidity
resulted in longer hospital stays and increased costs. Rough
calculations estimate that well over 50% of all infections and
ischemic events could have been prevented by avoiding RBC transfusion,
resulting in a 40% reduction of hospital costs. When considered
with the mounting evidence of the deleterious effects of RBC
transfusion after cardiac surgery, this article suggests that
cardiac surgeons and intensivists should reexamine transfusion
triggers and avoid RBC transfusion whenever possible. See p
2544.
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ASSOCIATION OF DIETARY INTAKE OF SOY, BEANS, AND ISOFLAVONES WITH RISK OF CEREBRAL AND MYOCARDIAL INFARCTIONS IN JAPANESE POPULATIONS: THE JAPAN PUBLIC HEALTH CENTER–BASED (JPHC) STUDY COHORT I, by Kokubo et al.
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The public has keen interest in the relations of dietary products
to cardiovascular disease. Soy and isoflavones have been reported
to improve cardiovascular risk factors such as lipids, but their
relation to cardiovascular disease per se has been unclear.
Kokubo and colleagues studied dietary intake of soy and isoflavones
in about 40 000 middle-aged Japanese with over 500 000 person
years of follow-up over an average of 12 years. They demonstrated
that in women the highest levels of soy intake (
5 times/week
versus 0–2 times/week) was associated with a lower risk
of cerebral and myocardial infarctions and cardiovascular disease
mortality (hazard ratios 0.64, 0.55, and 0.31, respectively).
The association was stronger in postmenopausal women, but for
reasons that are not understood, the same protective association
was not observed in men. Further research into the mechanisms
of the protective effect of soy products on cardiovascular risk
factors and health are merited. See p
2553.
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Images in Cardiovascular Medicine
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Direct Visualization of a Transcatheter Pulmonary Valve Implantation
Within the Visible Heart: A Glimpse Into the Future. See p
e548.
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Correspondence
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See p
e549.
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IMPROVED NEUROLOGICAL OUTCOME...
INCREASED MORTALITY,...