OBJECTIVE: We investigated whether patients with out-of-hospital cardiac arrest (OHCA) due to an acute myocardial infarction without cardiogenic shock required higher doses of vasopressors with low targeted temperature management (TTM) after return of spontaneous circulation. METHODS: We included consecutive comatose patients resuscitated from OHCA between January 2011 and December 2013. Patients with return of spontaneous circulation, regional wall motion abnormality on echocardiography, and coronary artery stenosis of ≥70% on percutaneous coronary artery angiography were enrolled. These patients received 36°C TTM or 33°C TTM following approval of TTM by patients’ next-of-kin (36°C and 33°C TTM groups, respectively). The cumulative vasopressor index was compared between groups. RESULTS: During induction phase, dose of vasopressors did not differ between groups. In the maintenance phase, the norepinephrine dose was 0.37±0.57 and 0.26±0.91 µg·kg⁻¹·min⁻¹ in the 33°C and 36°C TTM groups, respectively (P<0.01). During the rewarming phase, the norepinephrine and dopamine doses were 0.49±0.60 and 9.67±9.60 mcg·kg⁻¹·min⁻¹ in the 33°C TTM group and 0.14±0.46 and 3.13±7.19 mcg·kg⁻¹·min⁻¹ in the 36°C TTM group, respectively (P<0.01). The median cumulative vasopressor index was 8 (interquartile range, 3 to 8) and 4 (interquartile range, 0 to 8) in the 33°C and 36°C TTM groups, respectively (P=0.03). CONCLUSION: In this study, patients with OHCA due to acute myocardial infarction without cardiogenic shock had an elevated vasopressor requirement with 33°C TTM compared to 36°C TTM during the maintenance and rewarming phases.
Angiography ; Coma ; Coronary Stenosis ; Coronary Vessels ; Dopamine ; Echocardiography ; Humans ; Hypothermia ; Myocardial Infarction* ; Norepinephrine ; Out-of-Hospital Cardiac Arrest* ; Rewarming ; Shock, Cardiogenic* ; Vasoconstrictor Agents

Background: Refractory ceramic fibers (RCFs) are a suspected carcinogen but have been widely used as insulations. Depending on the temperature, RCFs can transform into crystalline SiO2, which is a carcinogen that can be present in the air during bulk RCF handling. This study analyzed the physicochemical and morphological characteristics of RCFs at high temperatures and determined the exposure levels during the semiconductor scrubber maintenance. Methods: Sampling was conducted at a company that manufactures semiconductor scrubbers using RCFs as insulation. Bulk RCF samples were collected both before and after exposure to a scrubber temperature of 700°C. Airborne RCFs were collected during scrubber maintenance, and their characteristics were analyzed using microscopes. Results: The components of bulk RCFs were SiO2 and Al2O3, having an amorphous structure. Airborne RCFs were morphologically different from bulk RCFs in size, which could negatively affect maintenance workers’ health. 58% of airborne RCFs correspond to the size of thoracic and respirable fibers. RCFs did not crystallize at high temperatures. The exposure caused by airborne RCFs during the scrubber frame assembly and insulation replacement was higher than the occupational exposure limit. Conclusion Workers conducting insulation replacement are likely exposed to airborne RCFs above safe exposure limits. As RCFs are suspected carcinogens, this exposure should be minimized through prevention and precautionary procedures.