Browsing by Author "Li, Chao-Jui"

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Early Administration of Glutamine Protects Cardiomyocytes from Post-Cardiac Arrest Acidosis
(2016-01-01)
Lin, Yan-Ren
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Li, Chao-Jui
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Syu, Shih-Han
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Wen, Cheng-Hao
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Buddhakosai, Waradee
Postcardiac arrest acidosis can decrease survival. Effective medications without adverse side effects are still not well characterized. We aimed to analyze whether early administration of glutamine could improve survival and protect cardiomyocytes from postcardiac arrest acidosis using animal and cell models. Forty Wistar rats with postcardiac arrest acidosis (blood pH < 7.2) were included. They were divided into study (500 mg/kg L-alanyl-L-glutamine, n = 20) and control (normal saline,n = 20) groups. Each of the rats received resuscitation. The outcomes were compared between the two groups. In addition, cardiomyocytes derived from human induced pluripotent stem cells were exposed to HBSS with different pH levels (7.3 or 6.5) or to culture medium (control). Apoptosis-related markers and beating function were analyzed. We found that the duration of survival was significantly longer in the study group (n < 0.05). In addition, in pH 6.5 or pH 7.3 HBSS buffer, the expression levels of cell stress (p53) and apoptosis (caspase-3, Bcl-xL) markers were significantly lower in cardiomyocytes treated with 50 mM L-glutamine than those without L-glutamine (RT-PCR). L-glutamine also increased the beating function of cardiomyocytes, especially at the lower pH level (6.5). More importantly, glutamine decreased cardiomyocyte apoptosis and increased these cells' beating function at a low pH level.
Early Epinephrine Improves the Stabilization of Initial Post-resuscitation Hemodynamics in Children With Non-shockable Out-of-Hospital Cardiac Arrest
(2019-06-06)
Lin, Yan-Ren
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Li, Chao-Jui
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Huang, Cheng-Chieh
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Lee, Tsung-Han
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Chen, Tren-Yi
Background: In children with non-shockable out-of-hospital cardiac arrest, early epinephrine (EE) might help to establish the return of spontaneous circulation (ROSC) and be associated with survival. In the present study, we aimed to analyze the effects of EE on outcomes and post-resuscitation hemodynamics in children with non-shockable OHCA. Methods: This was a retrospective analysis of data from 216 children (<19 years) who had suffered non-traumatic and non-shockable OHCA and received epinephrine for resuscitation (Jan 1, 2006-Dec 31, 2014). Demographics, pre-/in-hospital information, and the time to the first dose of epinephrine were recorded. Early post-resuscitation hemodynamics (the first hour after sustained ROSC), survival and good neurological outcomes (Pediatric Cerebral Performance Category Scales 1 or 2) were analyzed by the time to epinephrine-classified as early (EE): <15 min, intermediate (IE): 15-30 min, or late (LE): >30 min. Results: Twenty-eight (13.0%) children survived to discharge, but only 17 (7.9%) had good neurological outcomes. In all, 41 (18.9%) children received EE; in comparison to IE and LE, this was significantly associated with tachycardia (73.9%) in the post-resuscitation period (p < 0.05). Tachycardia (OR: 7.41, 95% CI: 1.96-29.31) and hypertension (OR: 6.03, 95% CI: 1.85-13.77) were significantly associated with EE after adjusting for confounding factors. EE was also significantly associated with better overall outcomes than ME and LE (any ROSC, sustained ROSC, survival to the intensive care unit, admission, survival to discharge and good neurological outcomes, all p < 0.05). Conclusions: EE helped to establish ROSC but was also associated with more tachycardia and hypertension in the early post-resuscitation period. In children with non-traumatic and non-shockable OHCA, EE was associated with a higher survival rate and better neurological outcomes than were ME and LE.
Factors associated with sustained return of spontaneous circulation in children after out-of-hospital cardiac arrest of noncardiac origin
(2010-03-01)
Li, Chao-Jui
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Kung, Chia-Te
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Liu, Ber-Ming
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Chou, Chu-Chung
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Chang, Chin-Fu
Purpose: The study aimed to determine the factors predictive of sustained return of spontaneous circulation (ROSC) in children with out-of-hospital cardiac arrest (OHCA) of noncardiac origin. Methods: Eighty children were included in this retrospective study. The variables that lead to sustained ROSC and those that do not lead to sustained ROSC were analyzed. Survival analyses, including chance of achieving sustained ROSC and sum duration of ROSC, were conducted according to the duration of in-hospital cardiopulmonary resuscitation (CPR). Results: Etiologies of noncardiac OHCA differed significantly across different age groups (P < .001). Only 8.8% of children had initial arrest rhythms that were shockable. Predictors of sustained ROSC included the initial cardiac rhythm (P = .002), a shorter period between collapse and the first chest compression (P = .002), a shorter in-hospital CPR duration (P = .004), and prehospital CPR (P = .007). In children where ROSC was initially sustained, those with in-hospital CPR of more than 20 minutes, ROSC was sustained for less time (P < .001). Conclusions: Few children with noncardiac OHCA present with shockable cardiac rhythms. Furthermore, long-term ROSC is difficult to maintain in children who receive in-hospital CPR for more than 20 minutes. (C) 2010 Elsevier Inc. All rights reserved.
Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest
(2016-03-01)
Lin, Yan-Ren
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Syue, Yuan-Jhen
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Buddhakosai, Waradee
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Lu, Huai-En
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Chang, Chin-Fu
The postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest (OHCA) might be impacted by the early administration of epinephrine, but this topic has not been well addressed. The aim of this study was to analyze the early postresuscitative hemodynamics, survival, and neurologic outcome according to different time points of first epinephrine treatment among children with traumatic OHCA.Information on 388 children who presented to the emergency departments of 3 medical centers and who were treated with epinephrine for traumatic OHCA during the study period (2003-2012) was retrospectively collected. The early postresuscitative hemodynamic features (cardiac functions, end-organ perfusion, and consciousness), survival, and neurologic outcome according to different time points of first epinephrine treatment (early: <15, intermediate: 15-30, and late: >30minutes after collapse) were analyzed.Among 165 children who achieved sustained return of spontaneous circulation, 38 children (9.8%) survived to discharge and 12 children (3.1%) had good neurologic outcomes. Early epinephrine increased the postresuscitative heart rate and blood pressure in the first 30minutes, but ultimately impaired end-organ perfusion (decreased urine output and initial creatinine clearance) (all P<0.05). Early epinephrine treatment increased the chance of achieving sustained return of spontaneous circulation, but did not increase the rates of survival and good neurologic outcome.Early epinephrine temporarily increased heart rate and blood pressure in the first 30minutes of the postresuscitative period, but impaired end-organ perfusion. Most importantly, the rates of survival and good neurologic outcome were not significantly increased by early epinephrine administration.
Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest
(2010-04-01)
Lin, Yan-Ren
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Li, Chao-Jui
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Wu, Tung-Kung
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Chang, Yu-Jun
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Lai, Shih-Chang
Aim of the study: Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic out-of-hospital cardiac arrest (OHCA) in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge. The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival to hospital discharge. Methods: We retrospectively evaluated the medical records of 228 children who presented to the emergency department without spontaneous circulation following non-traumatic OHCA during the period January 1996 to December 2008. Among these children, 80 achieved sustained ROSC for at least 20 min. The post-resuscitative clinical features during the first hour after achieving sustained ROSC that correlated with survival, median duration of survival, and death were analyzed. Results: Among the 80 children who achieved sustained ROSC for at least 20 min, 28 survived to hospital discharge and 6 had good neurologic outcomes (PCPC scale = 1 or 2). Post-resuscitative clinical features associated with survival included sinus cardiac rhythm (p = 0.012), normal heart rate (p = 0.008), normal blood pressure (p < 0.001), urine output > 1 ml/kg/h (p = 0.002), normal skin color (p = 0.016), lack of cardiopulmonary resuscitation (CPR)-induced rib fracture (p = 0.044), initial Glasgow Coma Scale score > 7 (p < 0.001), and duration of in-hospital CPR <= 10 min (p < 0.001). Furthermore, these variables were also significantly associated with the duration of survival (all p < 0.05). Conclusions: The most important predictors of survival to hospital discharge in children with OHCA who achieve sustained ROSC are a normal heart rate, normal blood pressure, and an initial urine output > 1 ml/kg/h. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
Predictors of survival and neurologic outcomes in children with traumatic out-of-hospital cardiac arrest during the early postresuscitative period
(2013-09-01)
Lin, Yan-Ren
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Wu, Han-Ping
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Chen, Wen-Liang
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Wu, Kuan-Han
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Teng, Tsung-Han
BACKGROUND: The outcome of children with traumatic out-of-hospital cardiac arrest (OHCA) is poor, and the information regarding survival in the postresuscitative period is limited. The aim of this study was to determine the clinical features during the early postresuscitative period that may predict survival or neurologic outcomes in children with traumatic OHCA. METHODS: Information on 362 children (<19 years) who presented to the emergency departments of three medical centers and experienced traumatic OHCA during the study period (January 2003 to December 2010) were retrospectively included. The postresuscitative clinical features during the early postresuscitative period, defined as the first hour after achieving sustained return of spontaneous circulation, which correlated with survival and neurologic outcomes were analyzed. RESULTS: Among 152 children (42%) who achieved sustained return of spontaneous circulation, 34 (9.4%) survived to discharge, and 11 (3%) had good neurologic outcomes (Pediatric Cerebral Performance Category Scale, 1 or 2). Early postresuscitative clinical features, which reflected initial cardiac output and end-organ perfusion, can predict the chance of survival. Such features included the following: high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color (all p < 0.05). Initial Glasgow Coma Scale (GCS) score of greater than 7 predicted a good neurologic outcome in survivors (p = 0.008). CONCLUSION: Predictors of survival were high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color. Most importantly, initial GCS score of greater than 7 predicted a good neurologic outcome in survivors. (Copyright (C) 2013 by Lippincott Williams & Wilkins)
Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children
(2019-11-11)
Syue, Yuan-Jhen
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Li, Chao-Jui
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Chen, Wen-Liang
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Lee, Tsung-Han
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Huang, Cheng-Chieh
Background The initial episode of angioedema in children can be potential life-threatening due to the lack of prompt identification and treatment. We aimed to analyze the factors predicting the severity and outcomes of the first attack of acute angioedema in children. Methods This was a retrospective study with 406 children (< 18 years) who presented in the emergency department (ED) with an initial episode of acute angioedema and who had subsequent follow-up visits in the out-patient department from January 2008 to December 2014. The severity of the acute angioedema was categorized as severe (requiring hospital admission), moderate (requiring a stay in the short-term pediatric observation unit [POU]), or mild (discharged directly from the ED). The associations among the disease severity, patient demographics and clinical presentation were analyzed. Result In total, 109 (26.8%) children had severe angioedema, and the majority of those children were male (65.1%). Most of the children were of preschool age (56.4%), and only 6.4% were adolescents. The co-occurrence of pyrexia or urticaria, etiologies of the angioedema related to medications or infections, the presence of respiratory symptoms, and a history of allergies (asthma, allergic rhinitis) were predictors of severe angioedema (all p < 0.05). Finally, the duration of angioedema was significantly shorter in children who had received short-term POU treatment (2.1 +/- 1.1 days) than in those who discharged from ED directly (2.3 +/- 1.4 days) and admitted to the hospital (3.5 +/- 2.0 days) (p < 0.001). Conclusion The co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema. More importantly, short-term POU observation and prompt treatment might be benefit for patients who did not require hospital admission.
The Post-Resuscitative Urinalysis Associate the Survival of Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest
(2013-10-04)
Chang, Chin-Fu
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Li, Chao-Jui
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Ko, Chih-Jan
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Teng, Tsung-Han
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Lai, Shih-Chang
Objective: To analyze whether urine output and urinalysis results are predictive of survival and neurologic outcomes in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). Methods: Information was obtained from 1,340 patients with non-traumatic OHCA who had achieved a sustained return of spontaneous circulation (ROSC). Factors that were associated with survival in the post-resuscitative period were evaluated. The association between urine output and fluid challenge in the early resuscitative period was analyzed and compared between the survivors and the non-survivors. The results of the initial urinalysis, including the presence of proteinuria and other findings, were used to evaluate the severity of vascular protein leakage and survival. The association between proteinuria and the neurologic outcomes of the survivors was also analyzed. The clinical features of capillary leakage were examined during the post-resuscitative period. Results: Of the 1,340 patients, 312 survived. A greater urine output was associated with a higher chance of survival. The initial urine output increased in proportion to the amount of fluid that was administered during early resuscitation in the emergency department for the survivors but not for the non-survivors (p<0.05). In the initial urinalysis, proteinuria was strongly associated with survival, and severe proteinuria indicated significantly poorer neurologic outcomes (p<0.05 for both comparisons). Proteinuria was associated with a risk of developing signs of capillary leakage, including body mass index gain and pitting edema (both p<0.001). Conclusion: The severity of proteinuria during the early post-resuscitative period was predictive of survival.
Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study
(2019-10-13)
Huang, Cheng-Chieh
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Lan, Hao-Min
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Li, Chao-Jui
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Lee, Tsung-Han
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Chen, Wen-Liang
Objective. To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy (COT) or noninvasive ventilation (NIV) for the treatment of acute respiratory failure (ARF) in emergency departments (EDs). Method. We comprehensively searched 3 databases (PubMed, EMBASE, and the Cochrane Library) for articles published from database inception to 12 July 2019. This study included only randomized controlled trials (RCTs) that were conducted in EDs and compared HFNC therapy with COT or NIV. The primary outcome was the intubation rate. The secondary outcomes were the mortality rate, intensive care unit (ICU) admission rate, ED discharge rate, need for escalation, length of ED stay, length of hospital stay, and patient dyspnea and comfort scores. Result. Five RCTs (n = 775) were included. There was a decreasing trend regarding the application of HFNC therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% CI, 0.26-1.09; p=0.08; I-2 = 0%). We found that compared with patients who underwent COT, those who underwent HFNC therapy had a reduced need for escalation (RR, 0.41; 95% CI, 0.22-0.78; p=0.006; I-2 = 0%), reduced dyspnea scores (MD -0.82, 95% CI -1.45 to -0.18), and improved comfort (SMD -0.76 SD, 95% CI -1.01 to -0.51). Compared with the COT group, the HFNC therapy group had a similar mortality rate (RR, 1.25; 95% CI, 0.79-1.99; p=0.34; I-2 = 0%), ICU admission rate (RR, 1.11; 95% CI, 0.58-2.12; p=0.76; I-2 = 0%), ED discharge rate (RR, 1.04; 95% CI, 0.63-1.72; p=0.87; I-2 = 0%), length of ED stay (MD 1.66, 95% CI -0.95 to 4.27), and hospital stay (MD 0.9, 95% CI -2.06 to 3.87). Conclusion. Administering HFNC therapy in ARF patients in EDs might decrease the intubation rate compared with COT. In addition, it can decrease the need for escalation, decrease the patient's dyspnea level, and increase the patient's comfort level compared with COT.