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Pubblicazioni recenti - cardiogenic
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[The Case of Fulminant Myocarditis].
Kardiologiia2019 Sep;59(9):91-96. doi: 10.18087/cardio.2019.9.n461.
Titov V A, Shishkova A A, Mitrofanova L B, Ivanova S V, Zverev D A, Marichev A O, Moiseeva O M,
Abstract
Fulminant myocarditis (FM) is a severe form of inflammatory myocardial injury rapidly developing as acute heart failure, cardiogenic shock, or life-threatening disturbances of cardiac rhythm. FM requires intensive treatment including drug therapy, mechanical circulatory support, and in some cases - heart transplantation. Echocardiography can be used as a screening method of diagnostics. Magnetic resonance imaging of the heart often cannot be performed because of hemodynamic instability of a patient, therefore endomyocardial biopsy with histological and immunohistochemical studies as well as molecular-genetic analysis of obtained samples is required for final diagnosis. Prognosis of the disease is determined by histological picture. In most cases, after cessation of acute stage of the inflammatory process, FM has a favorable long-term prognosis. In this article we present a clinical case of FM and review of current literature on diagnosis and treatment of this disease.
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[Hepatic dysfunction in patients with cardiogenic shock].
Med Klin Intensivmed Notfmed2019 Sep;():. doi: 10.1007/s00063-019-00618-6.
Kasper Philipp, Tacke Frank, Steffen Hans-Michael, Michels Guido,
Abstract
Cardiogenic shock is a life-threatening condition that is frequently associated with acute hepatic dysfunction. Due to low cardiac output resulting in end-organ hypoperfusion and hypoxia, different types of liver dysfunction can develop, such as hypoxic hepatitis or acute liver failure. A very serious and late sequela is the secondary sclerosing cholangitis in critically patients. Clinical management of acute hepatic dysfunction involves the stabilization of cardiac output to improve hepatic perfusion and the optimization of liver oxygenation. However, despite maximum efforts in supportive treatment, the outcome of patients with cardiogenic shock and concomitant hepatic dysfunction remains poor.
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Advancing Procedural Success in Cardiogenic Shock Among Elderly Patients: How Can We Improve?
JACC Cardiovasc Interv2019 Sep;12(18):1860-1862. doi: S1936-8798(19)31329-9.
Ohman E Magnus, Kochar Ajar,
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Procedural Success Rates and Mortality in Elderly Patients With Percutaneous Coronary Intervention for Cardiogenic Shock.
JACC Cardiovasc Interv2019 Sep;12(18):1853-1859. doi: S1936-8798(19)30944-6.
Zeymer Uwe, Hochadel Mathias, Karcher Ann-Kathrin, Thiele Holger, Darius Harald, Behrens Steffen, Schumacher Burghard, Ince Hüseyn, Hoffmeister Hans-Martin, Werner Nicolas, Zahn Ralf, ,
Abstract
OBJECTIVES:
The aim of this study was to determine the impact of age on procedural and clinical outcomes in patients with cardiogenic shock (CS).
BACKGROUND:
The use of early revascularization therapy with percutaneous coronary intervention (PCI) has been shown to improve outcome in patients with acute myocardial infarction (AMI) complicated by CS.
METHODS:
Data from consecutive patients with AMI and CS treated with PCI enrolled into the prospective ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte) PCI registry were centrally collected and analyzed. Patients were divided into 4 groups according to their age (<65, 65 to 74, 75 to 84, and >85 years). Patients' characteristics, procedural features, antithrombotic therapies, and in-hospital complications were compared among the 4 groups.
RESULTS:
Between 2010 and 2015, a total of 2,323 consecutive patients with AMI and CS were treated by PCI in 51 hospitals. TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 patency after PCI decreased with increasing age from 84% to 78%, while in-hospital mortality increased from 32% to 56%. Bleeding rates were low (2.0% to 2.3%) and not different among age groups. In the multivariate analysis, higher age, TIMI flow grade <3 after PCI, 3-vessel disease, and left main PCI were independent predictors of mortality.
CONCLUSIONS:
PCI in patients with AMI and CS is associated with a high procedural success rate and a low bleeding rate, even in very elderly patients, while mortality increases with increasing age. Because mortality in elderly patients with CS without revascularization therapy is very high, it seems justified to perform PCI in selected patients to reduce mortality.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Temporal Trends and Outcomes of Mechanical Complications in Patients With Acute Myocardial Infarction.
JACC Cardiovasc Interv2019 Sep;12(18):1825-1836. doi: S1936-8798(19)31020-9.
Elbadawi Ayman, Elgendy Islam Y, Mahmoud Karim, Barakat Amr F, Mentias Amgad, Mohamed Ahmed H, Ogunbayo Gbolahan O, Megaly Michael, Saad Marwan, Omer Mohamed A, Paniagua David, Abbott J Dawn, Jneid Hani,
Abstract
OBJECTIVES:
The aim of this study was to examine the temporal trends and outcomes of mechanical complications after myocardial infarction in the contemporary era.
BACKGROUND:
Data regarding temporal trends and outcomes of mechanical complications after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) are limited in the contemporary era.
METHODS:
The National Inpatient Sample database (2003 to September 2015) was queried to identify all STEMI and NSTEMI hospitalizations. Temporal trends and outcomes of mechanical complications after STEMI and NSTEMI, including papillary muscle rupture, ventricular septal defect, and free wall rupture, were described.
RESULTS:
The analysis included 3,951,861 STEMI and 5,114,270 NSTEMI hospitalizations. Mechanical complications occurred in 10,726 of STEMI hospitalizations (0.27%) and 3,041 of NSTEMI hospitalizations (0.06%), with no changes in trends (p = 0.13 and p = 0.83, respectively). The rates of in-hospital mortality in patients with mechanical complications were 42.4% after STEMI and 18.0% after NSTEMI, with no significant trend changes (p = 0.62 and p = 0.12, respectively). After multivariate adjustment, patients who had mechanical complications after myocardial infarction had higher in-hospital mortality, cardiogenic shock, acute kidney injury, hemodialysis, and respiratory complications compared with those without mechanical complications. Predictors of lower mortality in patients with mechanical complications who developed cardiogenic shock included surgical repair in the STEMI and NSTEMI cohorts and percutaneous coronary intervention in the STEMI cohort.
CONCLUSIONS:
Contemporary data from a large national database show that the rates of mechanical complications are low in patients presenting with STEMI and NSTEMI. Post-myocardial infarction mechanical complications continue to be associated with high mortality rates, which did not improve during the study period.
Copyright © 2019 American College of Cardiology Foundation. All rights reserved.
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Temporal Trends and Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement for Bicuspid Aortic Valve Stenosis.
JACC Cardiovasc Interv2019 Sep;12(18):1811-1822. doi: S1936-8798(19)31426-8.
Elbadawi Ayman, Saad Marwan, Elgendy Islam Y, Barssoum Kirolos, Omer Mohamed A, Soliman Ahmed, Almahmoud Mohamed F, Ogunbayo Gbolahan O, Mentias Amgad, Gilani Syed, Jneid Hani, Aronow Herbert D, Kleiman Neil, Abbott J Dawn,
Abstract
OBJECTIVES:
The purpose of this study was to assess the temporal trends of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS), and to compare the outcomes between TAVR and surgical aortic valve replacement (SAVR) in this population.
BACKGROUND:
Randomized trials comparing TAVR to SAVR in AS with bicuspid valve are lacking.
METHODS:
The study queried the National Inpatient Sample database (years 2012 to 2016) to identify hospitalizations for bicuspid AS who underwent isolated aortic valve replacement. A propensity-matched analysis was used to compare outcomes of hospitalizations for TAVR versus SAVR for bicuspid AS and TAVR for bicuspid AS versus tricuspid AS.
RESULTS:
The analysis included 31,895 hospitalizations with bicuspid AS, of whom 1,055 (3.3%) underwent TAVR. TAVR was increasingly utilized during the study period for bicuspid AS (p = 0.002). After matching, TAVR and SAVR had similar in-hospital mortality (3.1% vs. 3.1%; odds ratio: 1.00; 95% confidence interval: 0.60 to 1.67). There was no difference between TAVR and SAVR in the rates of cardiac arrest, cardiogenic shock, acute kidney injury, hemopericardium, cardiac tamponade, or acute stroke. TAVR was associated with lower rates of acute myocardial infarction, post-operative bleeding, vascular complications, and discharge to nursing facility as well as a shorter length of hospital stay. On the contrary, TAVR was associated with a higher incidence of complete heart block and permanent pacemaker insertion. TAVR for bicuspid AS was associated with similar in-hospital mortality compared with tricuspid AS.
CONCLUSIONS:
This nationwide analysis showed similar in-hospital mortality for TAVR and SAVR in patients with bicuspid AS. TAVR for bicuspid AS was also associated with similar in-hospital mortality compared with tricuspid AS. Further studies are needed to evaluate long-term outcomes of TAVR for bicuspid AS.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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The emerging value of serum D-dimer measurement in the work-up and management of ischemic stroke.
Int J Stroke2019 Sep;():1747493019876538. doi: 10.1177/1747493019876538.
Ohara Tomoyuki, Farhoudi Mehdi, Bang Oh Young, Koga Masatoshi, Demchuk Andrew M,
Abstract
BACKGROUND:
Elevated D-dimer levels are a marker of both thrombin formation and fibrinolysis. Currently D-dimer measurement is routinely used for ruling out venous thromboembolism and diagnosis/monitoring of disseminated intravascular coagulation. Recent emerging data suggest that D-dimer may become an important biomarker in ischemic stroke as well as in cardiovascular diseases.
AIMS:
To outline the clinical utility of D-dimer in work-up and management of ischemic stroke.
SUMMARY:
D-dimer measurement is most useful in stroke with active cancer as it can confirm etiologic diagnosis, predict recurrent stroke risk, and aid treatment decision in cancer-associated stroke. In cryptogenic stroke, high D-dimer levels can also provide clues for the cause of stroke as occult cancer and undetected cardiac embolic source as occult atrial fibrillation and may be helpful in treatment decision making of secondary stroke prevention. Serial D-dimer measurements should be further studied to monitor antithrombotic therapy effectiveness in both cardiogenic and cryptogenic etiologies.
CONCLUSION:
Accumulating data suggests the utility of D-dimer test in the management of ischemic stroke, although the evidence is still limited. Future studies would clarify the role of D-dimer measurement in ischemic stroke.
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Efficacy of immunosuppressants with bridge vasodilator therapy in severe lupus erythematosus-associated pulmonary arterial hypertension.
ESC Heart Fail2019 Sep;():. doi: 10.1002/ehf2.12507.
Sanges Sébastien, Savale Laurent, Lamblin Nicolas, Rémy-Jardin Martine, Humbert Marc, Sobanski Vincent,
Abstract
Optimal management of systemic lupus erythematosus (SLE)-associated pulmonary arterial hypertension (PAH) remains unclear. Our observation describes the case of a 31-year-old SLE patient presenting with cardiogenic shock revealing severe PAH, in which a therapeutic scheme combining immunosuppressants (pulse cyclophosphamide and corticosteroids) and PAH-specific drugs (bosentan, tadalafil, and epoprostenol) led to a complete normalization of pulmonary haemodynamics and allowed a progressive weaning of PAH vasodilators. This case report supports the efficacy of immunosuppressants and use of PAH-specific therapy as a bridge therapy in severe SLE-PAH. Further studies on larger population are required to confirm these findings.
© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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A Breath Close To Death: A Case Report Of Idiosyncratic Reaction To Welding Fumes.
J Ayub Med Coll Abbottabad;31(3):469-471.
Saeed Tamar, Bashir Jawad, Hameed Fawad,
Abstract
A 39-year-old gentleman presented to emergency department with a few hours' history of acute shortness of breath, cough and haemoptysis that developed whilst welding a steel tank in a closed container. He was welder by profession for thirteen years with no significant past medical history. The arterial blood gas showed severe oxygenation impairment and he was intubated for mechanical ventilation. The radiographs showed bilateral widespread interstitial shadowing. The echocardiography showed normal heart and ruled out cardiogenic pulmonary oedemic. The microbiological investigations were all normal. He was treated as Acute Respiratory Distress Syndrome (ARDS) secondary to exposure to welding metal fumes in a closed container. He was given limited tidal volume invasive ventilation, extubated successfully after twelve days, transferred to respiratory ward for rehabilitation and discharged few days later. Exposure to welding metal fumes at work place is a major occupational health hazard worldwide. It can cause ARDS and other respiratory illnesses such as bronchitis, metal fumes fever and chronic pneumonitis. The pathogenesis of ARDS due to welding metal fumes involves direct inhalational injury and/or immune system dysfunction. Welding metal fumes related ARDS remains the diagnosis of exclusion and all other causes must be ruled out. The key to treatment is ventilation support with early endotracheal intubation. Appropriate precautionary measures are advised to avoid occupational health hazards in welding profession.
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Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience.
Crit Care2019 Sep;23(1):320. doi: 10.1186/s13054-019-2605-4.
Zotzmann Viviane, Rilinger Jonathan, Lang Corinna N, Kaier Klaus, Benk Christoph, Duerschmied Daniel, Biever Paul M, Bode Christoph, Wengenmayer Tobias, Staudacher Dawid L,
Abstract
BACKGROUND:
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be a rescue therapy for patients in cardiogenic shock or in refractory cardiac arrest. After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients.
METHODS:
Analysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy.
RESULTS:
A total of 231 patients (age 58.6?±?14.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24?h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (p?=?0.034/p?=?0.005) and cumulative incidence of in-hospital death (p?=?0.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38, p?=?0.011) as well as after propensity score matching (OR 0.24, p?=?0.037). We found no significant differences between patients with inodilator treatment and those without.
CONCLUSION:
Early epinephrine therapy within the first 24?h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.
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Temporal trends, predictors, and outcomes of acute kidney injury and hemodialysis use in acute myocardial infarction-related cardiogenic shock.
PLoS One2019 ;14(9):e0222894. doi: 10.1371/journal.pone.0222894.
Vallabhajosyula Saraschandra, Dunlay Shannon M, Barsness Gregory W, Vallabhajosyula Saarwaani, Vallabhajosyula Shashaank, Sundaragiri Pranathi R, Gersh Bernard J, Jaffe Allan S, Kashani Kianoush,
Abstract
BACKGROUND:
There are limited data on acute kidney injury (AKI) complicating acute myocardial infarction with cardiogenic shock (AMI-CS). This study sought to evaluate 15-year national prevalence, temporal trends and outcomes of AKI with no need for hemodialysis (AKI-ND) and requiring hemodialysis (AKI-D) following AMI-CS.
METHODS:
This was a retrospective cohort study from 2000-2014 from the National Inpatient Sample (20% stratified sample of all community hospitals in the United States). Adult patients (>18 years) admitted with a primary diagnosis of AMI and secondary diagnosis of CS were included. The primary outcome was in-hospital mortality in cohorts with no AKI, AKI-ND, and AKI-D. Secondary outcomes included predictors, resource utilization and disposition.
RESULTS:
During this 15-year period, 440,257 admissions for AMI-CS were included, with AKI in 155,610 (35.3%) and hemodialysis use in 14,950 (3.4%). Older age, black race, non-private insurance, higher comorbidity, organ failure, and use of cardiac and non-cardiac organ support were associated with the AKI development and hemodialysis use. There was a 2.6-fold higher adjusted risk of developing AKI in 2014 compared to 2000. Presence of AKI-ND and AKI-D was associated with a 1.3 and 1.7-fold higher adjusted risk of mortality. Compared to the cohort without AKI, AKI-ND and AKI-D were associated with longer length of stay (9±10, 12±13, and 18±19 days respectively; p<0.001) and higher hospitalization costs ($101,859±116,204, $159,804±190,766, and $265,875 ± 254,919 respectively; p<0.001).
CONCLUSION:
AKI-ND and AKI-D are associated with higher in-hospital mortality and resource utilization in AMI-CS.
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The effects of multimedia education on postoperative delirium in patients undergoing coronary artery bypass graft: A randomized clinical trial.
Nurs Crit Care2019 Sep;():. doi: 10.1111/nicc.12473.
Fahimi Kosar, Abbasi Ali, Zahedi Mahdi, Amanpour Farzaneh, Ebrahimi Hossein,
Abstract
BACKGROUND:
Patients undergoing cardiac surgeries are at high risk of developing delirium.
AIMS AND OBJECTIVES:
The present study aimed to determine the effects of multimedia education on postoperative delirium in patients undergoing a coronary artery bypass graft.
DESIGN:
This study was a randomized clinical trial.
METHODS:
In this study, 110 patients undergoing a coronary artery bypass graft were assigned to two groups, control and intervention. Patients in the intervention group received multimedia education, and those in the control group received routine training. The inclusion criteria were experiencing the coronary artery bypass graft for the first time and non-development of post-operative cardiogenic shock or myocardial rupture. After measuring the level of consciousness, patients were examined in terms of delirium using the confusion assessment method for the ICU scale twice a day from admission to discharge from the ICU. The data were statistically analysed using ? test and Fisher's exact test.
RESULTS:
Patients of both groups were matched in terms of demographics. The highest incidence of delirium was observed on the first day after surgery in the intervention group (14.5%) and in the morning of the second day after surgery (29.1%) in the control group. Moreover, there was a significant difference between the two groups in the incidence of delirium in the morning of the second, third, and fourth days after surgery as it was higher in the control group over these days.
CONCLUSION:
Considering the lower incidence of post-operative delirium in patients who experienced multimedia education rather than control group, the use of this non-pharmaceutical method is recommended to prevent delirium in such patients.
RELEVANCE TO CLINICAL PRACTICE:
Delirium is also an acute organic brain syndrome that often leads to complicated conditions after cardiac surgeries. Fortunately, delirium is a preventable issue. The implementation of multimedia education as a non-pharmacological approach had positive effects on patients' delirium.
© 2019 British Association of Critical Care Nurses.
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Red Blood Cell Distribution Width Is Associated with All-Cause Mortality in Critically Ill Patients with Cardiogenic Shock.
Med Sci Monit2019 Sep;25():7005-7015. doi: 10.12659/MSM.917436.
Wang Benji, Aihemaiti Gulandanmu, Cheng Bihuan, Li Xiaomei,
Abstract
BACKGROUND There is no previously published epidemiological study exploring the association between red blood cell distribution width (RDW) and mortality in patients with cardiogenic shock (CS). The aim of this study was to examine the association between RDW and the risk of all-cause mortality in these patients. MATERIAL AND METHODS We analyzed clinical data from the MIMIC-III V1.4 database. We collected data on each patient's demographic parameters, vital signs, laboratory parameters, vital signs, comorbidities, and scoring systems on ICU admission. Cox proportional hazards models were used to assess the association between RDW levels and the 30-day, 90-day, and 365-day mortality in patients with CS. RESULTS There were 1131 patients meeting inclusion criteria in our study. In multivariate analysis, following adjustment for age, sex, and ethnicity, higher RDW in tertiles and quintiles were all associated with increased risk of 30-day, 90-day, and 365-day all-cause mortality. Furthermore, after adjusting for more relevant confounders, RDW remained a significant predictor of risk of 30-day, 90-day, and 365-day mortality (tertile 3 versus tertile 1: HR, 95% CI: 1.66, 1.19-2.31; 1.73, 1.28-2.33; 1.80, 1.38-2.34). Similarly significant robust associations were found in RDW levels stratified by quintiles. CONCLUSIONS Higher RDW is associated with increased risk of all-cause mortality in critically ill patients with CS.
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Mortality and costs following extracorporeal membrane oxygenation in critically ill adults: a population-based cohort study.
Intensive Care Med2019 Sep;():. doi: 10.1007/s00134-019-05766-z.
Fernando Shannon M, Qureshi Danial, Tanuseputro Peter, Fan Eddy, Munshi Laveena, Rochwerg Bram, Talarico Robert, Scales Damon C, Brodie Daniel, Dhanani Sonny, Guerguerian Anne-Marie, Shemie Sam D, Thavorn Kednapa, Kyeremanteng Kwadwo,
Abstract
PURPOSE:
Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients. Little is known about population-level short- and long-term outcomes following ECMO, including healthcare use and health system cost across a wide range of sectors.
METHODS:
Population-based cohort study in Ontario, Canada (October 1, 2009-March 31, 2017) of adult patients (??18 years) receiving ECMO for cardiorespiratory support. We captured outcomes through linkage to health administrative databases. Primary outcome was mortality during hospitalization, as well as at 7 days, 30 days, 1 year, 2 years, and 5 years following ECMO initiation. We analyzed health system costs (in Canadian dollars) in the 1 year following the date of the index admission.
RESULTS:
A total of 692 patients were included. Mean (standard deviation [SD]) age was 51.3 (16.0) years. Median (interquartile range [IQR]) time to ECMO initiation from date of admission was 2 (0-9) days. In-hospital mortality was 40.0%. Mortality at 1 year, 2 years, and 5 years was 45.1%, 49.0%, and 57.4%, respectively. Among survivors, 78.4% were discharged home, while 21.2% were discharged to continuing care. Median (IQR) total costs in the 1 year following admission among all patients were Canadian $130,157 (Canadian $58,645-Canadian $240,763), of which Canadian $91,192 (Canadian $38,507-Canadian $184,728) were attributed to inpatient care.
CONCLUSIONS:
Hospital mortality among critically ill adults receiving ECMO for advanced cardiopulmonary support is relatively high, but does not markedly increase in the years following discharge. Survivors are more likely to be discharged home than to continuing care. Median costs are high, but largely reflect inpatient hospital costs, and not costs incurred following discharge.
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Impella-Induced Incessant Ventricular Tachycardia.
Ochsner J2019 ;19(3):248-251. doi: 10.31486/toj.18.0018.
Kaki Amir, Subahi Ahmed, Shokr Mohamed, Ibrahim Walid, Yassin Ahmed, Hasan Reema, Alraies M Chadi, Schreiber Theodore,
Abstract
The Impella 2.5 and Impella Cardiac Power (CP) devices (ABIOMED) are used to provide mechanical circulatory support for high-risk percutaneous coronary interventions or cardiogenic shock as a bridge to recovery or destination therapy. The Impella device has shown both efficacy and safety in patients presenting with cardiogenic shock. Performing clinical and hemodynamic assessments of patients presenting with cardiogenic shock is an important step to determine if mechanical circulatory support with an Impella device is indicated. A 62-year-old male presented with cardiogenic shock requiring Impella device support. Two days later, the patient developed incessant ventricular tachycardia. Transthoracic echocardiography showed that the Impella device had migrated out of the ventricular cavity. Once the position of the Impella device was adjusted, ventricular tachycardia immediately resolved. Our case emphasizes the importance of using imaging modalities such as transthoracic echocardiography to ensure correct positioning of an Impella device in the left ventricle to avoid complications.
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Obesity is associated with poor prognosis in cardiogenic arrest survivors receiving coronary angiography.
J Formos Med Assoc2019 Sep;():. doi: S0929-6646(19)30574-1.
Sung Chih-Wei, Huang Chien-Hua, Chen Wen-Jone, Chang Wei-Tien, Wang Chih-Hung, Wu Yen-Wen, Chen Wei-Ting, Chang Jia-How, Tsai Min-Shan,
Abstract
BACKGROUND:
The role of body mass index (BMI) in clinical outcomes in patients resuscitated from cardiac arrest (CA) has recently drawn attention. We evaluated the effect of BMI on the prognosis of patients successfully resuscitated from cardiogenic arrest.
METHODS:
This retrospective cohort study included 273 non-traumatic adult cardiogenic arrest survivors receiving coronary angiography after return of spontaneous circulation in three hospitals from January 2011 to September 2017. These patients were classified as underweight, normal-weight, overweight, and obese, based on BMI (<18.5; 18.5-24.9; 25.0-29.9; and ?30 kg/m, respectively). In-hospital mortality and poor neurological outcomes were compared among groups.
RESULTS:
The obese group had significantly higher rates of in-hospital mortality and poor neurological outcomes (cerebral performance scale = 3-5) than did the other groups (for underweight, normal-weight, overweight, and obese groups, in-hospital mortality rates were 38.5%, 29.8%, 39.0%, and 64.1%, respectively, p = 0.002; poor neurological outcomes were 53.9%, 43.8%, 47.0%, and 71.8%, respectively, p = 0.02). The obese group exhibited higher risks of in-hospital mortality and poor neurological outcomes than did the normal-weight group (in-hospital mortality: adjusted hazard ratio (aHR) = 5.21, 95% confidence interval (CI) 2.16-10.32, p < 0.001; poor neurological outcomes: aHR = 3.77, 95% CI 1.69-8.36, p = 0.002).
CONCLUSION:
Obesity was associated with higher risks of in-hospital mortality and poor neurological recovery.
Copyright © 2019. Published by Elsevier B.V.
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Ultra-high pre-membrane lung oxygen saturation in a patient on veno-arterial extracorporeal membrane oxygenation.
Perfusion2019 Sep;():267659119872661. doi: 10.1177/0267659119872661.
Zhang Sheng, Lin Ronghai, Jiang Yongpo, Mi YaFei, Xu Yinghe,
Abstract
A 55-year-old man who suffered from acute myocardial infarction complicated with cardiogenic shock was administered veno-arterial extracorporeal membrane oxygenation. Ultra-high pre-membrane lung oxygen saturation of 93% was observed. Transthoracic echocardiography revealed the presence of patent foramen ovale. The four-chamber view showed that the tip of the cannula was located in the patent foramen ovale, which resulted in a left-to-right shunt. Without adjusting the position of the drainage cannula, the patient was weaned from extracorporeal membrane oxygenation at 136?hours after initiation and survived to hospital discharge.
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Timely extracorporeal membrane oxygenation assist reduces mortality after bypass surgery in patients with acute myocardial infarction.
J Card Surg2019 Sep;():. doi: 10.1111/jocs.14258.
Hamiko Marwan, Slottosch Ingo, Scherner Max, Gestrich Christopher, Wahlers Thorsten, Putensen Christian, Mellert Fritz, Treede Hendrik, Dewald Oliver, Duerr Georg Daniel,
Abstract
BACKGROUND:
Patients with acute myocardial infarction (AMI) are at high risk when undergoing emergency coronary artery bypass graft (CABG)-surgery. Their outcome remains poor despite increased use of extracorporeal membrane oxygenation (ECMO). We investigated the impact of timing for perioperative ECMO-support in these patients.
METHODS:
In this retrospective double-center study, we evaluated 201 patients with AMI undergoing CABG, dividing them into the following groups: No-ECMO (n?=?101), preoperative ECMO (pre-ECMO, n?=?6), intraoperative ECMO (ECC-ECMO, n?=?67), and postoperative ECMO (post-ECMO, n?=?27). We evaluated the impact of ECMO timing on postoperative mortality, organ function, and length of stay, comparing these to predicted outcome using different risk-scores.
RESULTS:
Post-ECMO patients showed lowest 30-day-survival (40.7%), while earlier ECMO-start was associated with better outcome (50.7% in extracorporeal circulation [ECC]-ECMO and 66.7% in pre-ECMO patients). On admission, only pre-ECMO and ECC-ECMO patients showed higher surgery- and intensive-care-unit (ICU)-related risk-scores. In pre- and ECC-ECMO patients, the first significant increase in lactate-levels (>4?mmol/L) was observed preoperatively, while this occurred 1 hour postoperatively in post-ECMO patients. Bilirubin was increased in all patients, decreasing after 3 and 12 days in pre- and ECC-ECMO patients, respectively, but only after 18 days in post-ECMO patients. Multiple ICU risk-scores did not discriminate survival-probability correctly. Only the ECMO-related survival after veno-arterial-ECMO-score correctly predicted the significantly lower survival in post-ECMO patients.
CONCLUSION:
Our study shows that timely ECMO-support is associated with earlier bilirubin-downtrend and higher survival in patients with AMI after CABG. Lactate-increase greater than 4?mmol/L seems to be a helpful threshold to trigger the timely onset of ECMO-therapy, providing better survival.
© 2019 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals, Inc.
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A diver's guide to subaquatic envenomation in the Mediterranean.
Diving Hyperb Med2019 Sep;49(3):225-228. doi: 10.28920/dhm49.3.225-228.
Todd James, Edsell Mark,
Abstract
INTRODUCTION:
Between 40,000 and 50,000 divers and swimmers are envenomated each year and diving as a hobby is becoming increasingly popular. In the Mediterranean, envenomation is most often by Weever fish, Scorpion fish and jellyfish but coral and sea urchins may also be venomous.
ENVENOMATION:
Most stings cause local inflammation, oedema and pain. The severity of pain varies with the venom and the amount injected. In severe cases, stings may be life-threatening due to cardiogenic or anaphylactic shock or penetration of vital structures.
MANAGEMENT:
Most cases of envenomation are preventable with a combination of measures including the avoidance of contact through good buoyancy control, the wearing of body-suits, and by maintaining visual awareness. Immediate management is to return to the surface, elevate and wash the site of injury. Immersion in hot water followed by simple analgesics for pain relief has been shown to be more effective than other methods. More severe cases should be identified by symptoms including confusion and heavy bleeding and referred to qualified medical care.
CONCLUSION:
Envenomation by subaquatic species is common and preventable yet the dissemination of the appropriate knowledge is limited. This knowledge summary provides pertinent information aimed at divers in preventing and managing such injuries.
Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.
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Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 1-Adult patients.
J Heart Lung Transplant2019 Aug;():. doi: S1053-2498(19)31632-8.
Lorusso Roberto, Raffa Giuseppe Maria, Alenizy Khalid, Sluijpers Niels, Makhoul Maged, Brodie Daniel, McMullan Mike, Wang I-Wen, Meani Paolo, MacLaren Graeme, Kowalewski Mariusz, Dalton Heidi, Barbaro Ryan, Hou Xiaotong, Cavarocchi Nicholas, Chen Yih-Sharng, Thiagarajan Ravi, Alexander Peta, Alsoufi Bahaaldin, Bermudez Christian A, Shah Ashish S, Haft Jonathan, D'Alessandro David A, Boeken Udo, Whitman Glenn J R,
Abstract
Cardiogenic shock, cardiac arrest, acute respiratory failure, or a combination of such events, are all potential complications after cardiac surgery which lead to high mortality. Use of extracorporeal temporary cardio-circulatory and respiratory support for progressive clinical deterioration can facilitate bridging the patient to recovery or to more durable support. Over the last decade, extracorporeal membrane oxygenation (ECMO) has emerged as the preferred temporary artificial support system in such circumstances. Many factors have contributed to widespread ECMO use, including the relative ease of implantation, effectiveness, versatility, low cost relative to alternative devices, and potential for full, not just partial circulatory support. While there have been numerous publications detailing the short and midterm outcomes of ECMO support, specific reports about post-cardiotomy ECMO (PC-ECMO), are limited, single-center experiences. Etiology of cardiorespiratory failure leading to ECMO implantation, associated ECMO complications, and overall patient outcomes may be unique to the PC-ECMO population. Despite the rise in PC-ECMO use over the past decade, short-term survival has not improved. This report, therefore, aims to present a comprehensive overview of the literature with respect to the prevalence of ECMO use, patient characteristics, ECMO management, and in-hospital and early post-discharge patient outcomes for those treated for post-cardiotomy heart, lung, or heart-lung failure.
Copyright © 2019 International Society for Heart and Lung Transplantation. All rights reserved.
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