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refractory shock

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https://www.readbyqxmd.com/read/29456606/sudden-cardiac-arrest-in-hypertrophic-cardiomyopathy-with-dynamic-cavity-obstruction-the-case-for-a-decatecholaminisation-strategy
#1
Cosmin Balan, Adrian View-Kim Wong
Catecholamines are entrenched in the management of shock states. A paradigm shift has pervaded the critical care arena in recent years acknowledging their propensity to cause harm and fuel a 'death-spiral'. We present the case of a 21-year-old male following a witnessed out-of-hospital cardiac arrest who received high-quality cardiopulmonary resuscitation and standard advanced life support for refractory ventricular fibrillation until return of spontaneous circulation after 70 min. Early post-admission echocardiography revealed severe diffuse sub-basal left ventricular hypertrophy with dynamic mid-cavity obstruction and akinetic apical pouching...
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29453484/late-presentation-of-post-diphtheritic-myocarditis-in-a-15-year-male
#2
Kutty Sharada Vinod, Nitin Gupta, Harsh Sahu, Naveet Wig
A 15-year old male patient presented to us with dyspnoea for four days. He had a history of fever, pseudo-membranous tonsillitis and cervical adenopathy twenty-five days prior to the presentation. On examination and laboratory investigations, he had features suggestive of myocarditis with biventricular failure. There was no reliable history of immunisation and he had a positive history of contact. He was planned for anti-diphtheria toxin but before the anti-toxin could be initiated, the patient succumbed to refractory cardiogenic shock...
October 2017: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/29450594/position-paper-for-the-organization-of-ecmo-programs-for-cardiac-failure-in-adults
#3
Darryl Abrams, A Reshad Garan, Akram Abdelbary, Matthew Bacchetta, Robert H Bartlett, James Beck, Jan Belohlavek, Yih-Sharng Chen, Eddy Fan, Niall D Ferguson, Jo-Anne Fowles, John Fraser, Michelle Gong, Ibrahim F Hassan, Carol Hodgson, Xiaotong Hou, Katarzyna Hryniewicz, Shingo Ichiba, William A Jakobleff, Roberto Lorusso, Graeme MacLaren, Shay McGuinness, Thomas Mueller, Pauline K Park, Giles Peek, Vin Pellegrino, Susanna Price, Erika B Rosenzweig, Tetsuya Sakamoto, Leonardo Salazar, Matthieu Schmidt, Arthur S Slutsky, Christian Spaulding, Hiroo Takayama, Koji Takeda, Alain Vuylsteke, Alain Combes, Daniel Brodie
Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices...
February 15, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29443857/the-fast-exam-can-reliably-identify-patients-with-significant-intraabdominal-hemorrhage-in-life-threatening-pelvic-fractures
#4
Nicole Townsend Christian, Clay Cothren Burlew, Ernest E Moore, Andrea E Geddes, Amy E Wagenaar, Charles J Fox, Fredric M Pieracci
BACKGROUND: The Focused Abdominal Sonography for Trauma (FAST) exam has been reported to be unreliable in pelvic fracture patients. Additionally, given the advent of new therapeutic interventions, such as Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), rapid identification of intraabdominal hemorrhage compared to zone III hemorrhage may guide different therapeutic strategies. We hypothesized that FAST is reliable for detecting clinically significant intraabdominal hemorrhage in the face of complex pelvic fractures...
February 14, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29439891/resuscitative-endovascular-balloon-occlusion-of-the-aorta-using-a-low-profile-device-is-easy-and-safe-for-emergency-physicians-in-cases-of-life-threatening-hemorrhage
#5
Takahiro Shoji, Takehiko Tarui, Takashi Igarashi, Yuki Mochida, Hiroyuki Morinaga, Yasuhiko Miyakuni, Yoshitaka Inoue, Yasuhiko Kaita, Hiroshi Miyauchi, Yoshihiro Yamaguchi
BACKGROUND: Bleeding from hemorrhagic shock can be immediately controlled by blocking the proximal part of the hemorrhagic point using either resuscitative thoracotomy for aortic cross-clamping or insertion of a large-caliber (10-14Fr) resuscitative endovascular balloon occlusion of the aorta (REBOA) device via the femoral artery. However, such methods are very invasive and have various complications. With recent progress in endovascular treatment, a low-profile REBOA device (7Fr) has been developed...
February 10, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29437814/isolated-splenic-mucormycosis-in-a-case-of-aplastic-anaemia
#6
Shefali K Sharma, Prasanth Balasubramanian, Bishan Radotra, Manphool Singhal
Mucormycosis, a rare opportunistic infection seen in immunocompromised hosts, is caused by fungi of Mucorales family. It may be confined to the organs, such as rhinocerebral and pulmonary mucormycosis, or may cause disseminated infection. A 14-year-old boy presented to our clinic with fever and left upper quadrant abdominal pain, and on evaluation was found to have pancytopaenia, and imaging revealed ill-defined splenic collection with thrombus in the splenic vein. He was started on empirical intravenous antibiotics, followed by antifungals empirically as he did not show any improvement clinically...
February 8, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29400656/outcome-after-revascularisation-of-acute-myocardial-infarction-with-cardiogenic-shock-on-extracorporeal-life-support
#7
Pavel Overtchouk, Julien Pascal, Guillaume Lebreton, Jean-Sebastien Hulot, Charles-Edouard Luyt, Alain Combes, Mathieu Kerneis, Johanne Silvain, Olvier Barthelemy, Pascal Leprince, Nicolas Brechot, Gilles Montalescot, Jean-Philippe Collet
AIMS: To identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with need for extracorporeal life support (ECLS). METHOD AND RESULTS: This observational single-tertiary-centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63...
February 6, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29397882/effectiveness-of-rescue-percutaneous-balloon-aortic-valvuloplasty-in-patients-with-severe-aortic-stenosis-and-acute-heart-failure
#8
Marc Eugène, Marina Urena, Jérémie Abtan, José-Luis Carrasco, Walid Ghodbane, Patrick Nataf, Alec Vahanian, Dominique Himbert
The prognosis of patients with cardiogenic shock (CS) or refractory pulmonary edema because of severe aortic stenosis remains poor. The purpose of this study was to assess the outcomes of rescue percutaneous balloon aortic valvuloplasty (PBAV) in the transcatheter aortic valve implantation (TAVI) era. Patients were consecutively included between 2008 and 2016. CS was defined as ≥1 sign of systemic hypoperfusion and need of catecholamines. Refractory pulmonary edema was defined as not controlled by optimal medical treatment...
December 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29386307/a-retrospective-analysis-of-etiology-and-outcomes-of-refractory-capd-peritonitis-in-a-tertiary-care-center-from-north-india
#9
Venkatesh Thammishetti, Anupama Kaul, Dharmendra S Bhadauria, Karthikeyan Balasubramanian, Narayan Prasad, Amit Gupta, Raj K Sharma
BACKGROUND: Refractory peritonitis is defined as failure of clearance of peritoneal fluid despite 5 days of appropriate antibiotic therapy. Catheter removal decreases morbidity and mortality. Data on the outcomes of refractory peritonitis and of reinitiation of peritoneal dialysis (PD) in this group of patients are sparse. The present study analyzed etiology, outcomes, and prognostic factors of refractory peritonitis as well as survival of the reinitiation of the technique. METHODS: This was a single-center retrospective study that included 90 patients of refractory continuous ambulatory PD (CAPD) peritonitis at a tertiary care center in North India...
January 31, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://www.readbyqxmd.com/read/29367330/angiotensin-ii-increases-blood-pressure-in-patients-with-refractory-vasodilatory-shock
#10
REVIEW
Giovanni Landoni, Alessandro Belletti
No abstract text is available yet for this article.
February 2018: Evidence-based Medicine
https://www.readbyqxmd.com/read/29356207/mexiletine-or-catheter-ablation-after-amiodarone-failure-in-the-vanish-trial
#11
Marc W Deyell, Christian Steinberg, Steve Doucette, Ratika Parkash, Isabelle Nault, Chris Gray, Vidal Essebag, Martin Gardner, Laurence D Sterns, Jeff S Healey, Tomasz Hruczkowski, Lena Rivard, Peter Leong-Sit, Pablo B Nery, John L Sapp
INTRODUCTION: In patients with ischemic heart disease and ventricular tachycardia (VT) refractory to high dose amiodarone, the two most common therapeutic options are adjunctive mexiletine therapy or catheter ablation. There is little existing data on the efficacy of these strategies. We examined the relative efficacy of adjunctive mexiletine and catheter ablation among patients enrolled in the VANISH trial. METHODS: All subjects enrolled in the VANISH trial who had VT refractory to high dose (≥ 300 mg daily) amiodarone at baseline were included...
January 22, 2018: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/29349674/extracorporeal-life-support-in-cardiogenic-shock-indications-and-management-in-current-practice
#12
REVIEW
C L Meuwese, F Z Ramjankhan, S A Braithwaite, N de Jonge, M de Jong, M P Buijsrogge, J G D Janssen, C Klöpping, J H Kirkels, D W Donker
Veno-arterial extracorporeal life support (VA-ECLS) provides circulatory and respiratory stabilisation in patients with severe refractory cardiogenic shock. Although randomised controlled trials are lacking, the use of VA-ECLS is increasing and observational studies repeatedly have shown treatment benefits in well-selected patients. Current clinical challenges in VA-ECLS relate to optimal management of the individual patient on extracorporeal support given its inherent complexity. In this review article we will discuss indications, daily clinical management and complications of VA-ECLS in cardiogenic shock refractory to conventional treatment strategies...
January 18, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29344963/refractory-pulmonary-edema-and-upper-body-hypoxemia-during-veno-arterial-extracorporeal-membrane-oxygenation-a-case-for-atrial-septostomy
#13
Amit Prasad, Ali Ghodsizad, Christoph Brehm, Mark Kozak, Michael Körner, Aly El Banayosy, Kai Singbartl
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides mechanical circulatory support for patients with advanced cardiogenic shock, facilitating myocardial recovery and limiting multi-organ failure. In patients with severely limited left ventricular ejection, peripheral VA-ECMO can further increase left ventricular and left atrial pressures (LAP). Failure to decompress the left heart under these circumstances can result in pulmonary edema and upper body hypoxemia, that is, myocardial and cerebral ischemia...
January 18, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29329694/management-of-refractory-vasodilatory-shock
#14
REVIEW
Jacob C Jentzer, Saraschandra Vallabhajosyula, Ashish K Khanna, Lakhmir S Chawla, Laurence W Busse, Kianoush B Kashani
Refractory shock is a lethal manifestation of cardiovascular failure defined by an inadequate hemodynamic response to high doses of vasopressor medications. Approximately 7% of critically ill patients will develop refractory shock, with short-term mortality exceeding 50%. Refractory vasodilatory shock develops from uncontrolled vasodilation and vascular hyporesponsiveness to endogenous vasoconstrictors, causing failure of physiologic vasoregulatory mechanisms. Standard approaches to the initial management of shock include fluid resuscitation and initiation of norepinephrine...
January 9, 2018: Chest
https://www.readbyqxmd.com/read/29306448/fulminant-giant-cell-myocarditis-on-mechanical-circulatory-support-management-and-outcomes-of-a-french-multicentre-cohort
#15
Santiago Montero, Nadia Aissaoui, Jean-Marc Tadié, Philippe Bizouarn, Vincent Scherrer, Romain Persichini, Clément Delmas, Florence Rolle, Emmanuel Besnier, Alexandre Le Guyader, Alain Combes, Matthieu Schmidt
AIMS: Giant-cell myocarditis (GCM) is a rare and often fatal form of myocarditis. Only a few reports have focused on fulminant forms. We describe the clinical characteristics, management and outcomes of GCM patients rescued by mechanical circulatory support (MCS). METHODS AND RESULTS: The clinical features, diagnoses, treatments and outcomes of MCS-treated patients in refractory cardiogenic shock secondary to fulminant GCM admitted to eight French intensive care units (2002-2016) were analysed...
February 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29305400/effect-of-baseline-antiarrhythmic-drug-on-outcomes-with-ablation-in-ischemic-ventricular-tachycardia-a-vanish-substudy-ventricular-tachycardia-ablation-versus-escalated-antiarrhythmic-drug-therapy-in-ischemic-heart-disease
#16
Ratika Parkash, Isabelle Nault, Lena Rivard, Lorne Gula, Vidal Essebag, Pablo Nery, Stanley Tung, Jean-Marc Raymond, Laurence Sterns, Steve Doucette, George Wells, Anthony S L Tang, William G Stevenson, John L Sapp
BACKGROUND: The VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) compared the effectiveness of escalated antiarrhythmic drug therapy to catheter ablation in patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia (VT). The effectiveness of these interventions in patients on sotalol versus amiodarone was compared. METHODS AND RESULTS: Analysis was conducted based on whether patients had recurrent VT, despite amiodarone (amio-refractory) or nonamiodarone drugs (sotalol-refractory)...
January 2018: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29303795/nonejecting-hearts-on-femoral-veno-arterial-extracorporeal-membrane-oxygenation-aortic-root-blood-stasis-and-thrombus-formation-a-case-series-and-review-of-the-literature
#17
Hanane Hireche-Chikaoui, Martin R Grübler, Andreas Bloch, Stephan Windecker, Stefan Bloechlinger, Lukas Hunziker
OBJECTIVES: Cardiogenic shock constitutes the final common pathway of cardiac dysfunction associated with tissue hypoperfusion and organ failure. Besides treatment of the underlying cause, temporary mechanical circulatory support serves as a supportive measure. Extracorporeal membrane oxygenation can effectively prevent hypoxemia and end-organ dysfunction, but knowledge about patient selection, risks, and complications remains sparse. DATA SOURCES: Clinical observation...
January 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29303029/the-use-of-ecmo-for-the-treatment-of-refractory-cardiac-arrest-or-postarrest-cardiogenic-shock-following-in-hospital-cardiac-arrest-a-10-year-experience
#18
Meshe Chonde, Penny Sappington, Robert Kormos, Andrew Althouse, Arthur Boujoukos
OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has been increasingly used in the treatment of refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation [ECPR]) and postarrest cardiogenic shock (PACS). Our primary objective was to determine the 1-year survival of patients who were treated with ECMO for PACS or in ECPR. METHODS: We conducted a retrospective analysis of hospitalized patients in a tertiary care facility who underwent treatment with ECMO for ECPR or PACS...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29281011/extracorporeal-membrane-oxygenation-for-cardiogenic-shock-due-to-alcoholic-cardiomyopathy-a-long-term-follow-up-of-4-cases
#19
Dorothee Valance, Bruno Bouchet, Caroline Brulliard, Benjamin Delmas, Berenice Puech, Eric Braunberger, Nicolas Allou, Jerome Allyn
Even though alcoholism is a major health concern, alcoholic cardiomyopathy is a little-known pathology. The exact prevalence remains elusive (20-40% of dilated cardiomyopathy). However, it can lead to dilated cardiomyopathy, heart failure and refractory cardiogenic shock. The literature on cardiogenic shock in alcoholic cardiomyopathy is limited. We report 4 cases of patients with refractory cardiogenic shock due to heavy alcohol consumption, who were treated with venoarterial extracorporeal membrane oxygenation...
December 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29275390/hhv-8-associated-haemophagocytic-lymphohistiocytosis-in-a-patient-with-advanced-aids
#20
Saroja Bangaru, Amanda Strickland, Dominick Cavuoti, Nainesh Shah
We present a patient with advanced AIDS admitted with recurrent shock of unclear aetiology, fevers, altered mental status and refractory cytopenias. His case posed a diagnostic challenge because evaluation of septic shock in the setting of advanced AIDS requires a time-consuming work-up for broad infectious aetiologies that can delay consideration of other diagnoses, including primary or secondary haemophagocytic lymphohistiocytosis (HLH). After this patient did not improve with supportive care and empiric antimicrobials, there was concern for HLH given that he met ≥5 of the HLH consortium criteria...
December 22, 2017: BMJ Case Reports
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