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Circulatory shock

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https://www.readbyqxmd.com/read/29033819/an-unusual-presentation-of-pyoderma-gangrenosum-leading-to-systemic-inflammatory-response-syndrome
#1
Ali Didan, Alan Donnelly, Hock Chua
This is a report of an atypical presentation of pyoderma gangrenosum (PG) in a 26-year-old male who had a negative septic screen. The patient had a life-threatening presentation requiring an intensive care unit (ICU) admission for vasopressor support. It was thought that the likely cause of circulatory collapse was an overwhelming cytokine reaction or systemic inflammatory response syndrome (SIRS) secondary to extensive PG lesions rather than septic shock. The patient presented with multiple large ulcers, the largest being 4 cm in diameter on the central chest...
September 2017: Case Reports in Dermatology
https://www.readbyqxmd.com/read/29032225/right-ventricular-dysfunction-in-acute-myocardial-infarction-complicated-by-cardiogenic-shock-a-hemodynamic-analysis-of-the-should-we-emergently-revascularize-occluded-coronaries-for-cardiogenic-shock-shock-trial-and-registry
#2
Anuradha Lala, Yu Guo, Jinfeng Xu, Michele Esposito, Kevin Morine, Richard Karas, Stuart D Katz, Judith S Hochman, Daniel Burkhoff, Navin K Kapur
BACKGROUND: The prevalence and significance of right ventricular dysfunction (RVD) in patients with cardiogenic shock due to acute myocardial infarction (AMI-CS) has not been well characterized. We hypothesized that RVD is common in AMI-CS and associated with worse clinical outcomes. METHODS AND RESULTS: We retrospectively analyzed patients with available hemodynamics enrolled in the SHould we emergently revascularize Occluded coronaries for Cardiogenic shocK (SHOCK) Trial (n=139) and Registry (n=258) to identify RVD in AMI-CS...
October 11, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/29023857/preceding-haemorrhagic-shock-as-a-detrimental-risk-factor-for-respiratory-distress-after-excessive-allogeneic-blood-transfusion
#3
R Masuda, T Iijima, R Kondo, Y Itoda, M Matsuhashi, S Hashimoto, T Kohira, N Kobayashi, H Okazaki
BACKGROUND AND OBJECTIVES: Whether transfusion-associated circulatory overload arises as a simple result of over-transfusion or requires another trigger remains unclear. Here, we examined whether respiratory distress could be reproduced by massive transfusion alone in an animal model. MATERIALS AND METHODS: A total of 20 anaesthetized swine were equipped with monitors. Allogeneic blood was obtained from 10 donor swine. A 4-stage loading protocol with each stage equivalent to 25% of the blood volume (BV) in the recipient swine was then used to infuse crystalloid (CR), hydroxyethyl starch (HES) or allogeneic blood (TR) (n = 5 each)...
October 11, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/29020341/percutaneous-short-term-active-mechanical-support-devices-in-cardiogenic-shock-a-systematic-review-and-collaborative-meta-analysis-of-randomized-trials
#4
Holger Thiele, Alexander Jobs, Dagmar M Ouweneel, Jose P S Henriques, Melchior Seyfarth, Steffen Desch, Ingo Eitel, Janine Pöss, Georg Fuernau, Suzanne de Waha
Aims: Evidence on the impact on clinical outcome of active mechanical circulatory support (MCS) devices in cardiogenic shock (CS) is scarce. This collaborative meta-analysis of randomized trials thus aims to investigate the efficacy and safety of percutanzeous active MCS vs. control in CS. Methods and results: Randomized trials comparing percutaneous active MCS to control in patients with CS were identified through searches of medical literature databases. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated to analyse the primary endpoint of 30-day mortality and device-related complications including bleeding and leg ischaemia...
July 7, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28984705/the-crashing-patient-hemodynamic-collapse
#5
Hitesh Gidwani, Hernando Gómez
PURPOSE OF REVIEW: Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse. RECENT FINDINGS: The initial approach to the patient in cardiovascular collapse continues to be based on the Ventilate-Infuse-Pump rule...
October 4, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28984061/management-of-patients-with-cardiogenic-shock-on-temporary-mechanical-circulatory-support-urgent-transplantation-or-on-to-the-next-pump
#6
EDITORIAL
Finn Gustafsson
No abstract text is available yet for this article.
October 6, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28958014/intracardiac-and-pulmonary-artery-hydatidosis-causing-thromboembolic-pulmonary-hypertension
#7
Gökçen Orhan, Murat Bastopcu, Bülent Aydemir, Mehmet Sait Ersoz
Hydatidosis is a serious parasitic infection in endemic areas. A rare presentation is pulmonary arterial cysts causing thromboembolic pulmonary hypertension. We report the case of a young man who presented with clinical and radiological findings of thromboembolic pulmonary hypertension. The patient was found to have hydatid cysts in both pulmonary arteries and in the right ventricular outflow tract. To remove all cysts without causing rupture, anaphylactic shock or systemic emboli, placing the patient under cardiopulmonary arrest was necessary, and in the case of pulmonary arterial involvement, total circulatory arrest was necessary...
September 7, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28953635/sequential-organ-failure-assessment-predicts-outcomes-of-pulse-indicator-contour-continuous-cardiac-output-directed-goal-therapy-a-prospective-study
#8
Wei Zhang, Quzhen Danzeng, Xiaoting Feng, Xing Cao, Weiwei Chen, Yan Kang
According to the new sepsis definitions, septic shock is defined as a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. We evaluated the predictive efficacy of the Sequential Organ Failure Assessment (SOFA) score in critically ill patients with septic shock undergoing pulse indicator contour continuous cardiac output (PiCCO)-directed goal therapy (PDGT).We conducted a single-center, prospective, observational study of 52 patients with septic shock undergoing PDGT...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28948299/-cardiogenic-shock-current-evidence
#9
H Thiele
This CME article addresses the pathophysiology, incidence, current survival outcome and treatment options for patients with cardiogenic shock as a complication of acute myocardial infarction. The shock spiral of left heart failure due to cardiac infarction, subsequent vasoconstriction and paradoxical vasodilation due to the systemic inflammation response syndrome (SIRS) is a vicious circle which must be interrupted. Treatment focuses on the evidence from randomized clinical trials and the current guideline recommendations...
September 25, 2017: Herz
https://www.readbyqxmd.com/read/28944588/left-ventricular-perforation-after-impella%C3%A2-placement-in-a-patient-with-cardiogenic-shock
#10
David C Peritz, Lee Linstroth, Craig H Selzman, Edward M Gilbert
Mechanical cardiovascular support devices are now widely used both in the setting of cardiogenic shock as well as during high risk cardiac catheterization procedures. We report a case of a young female patient who presented with presumed myocarditis and rapidly deteriorating decompensated heart failure requiring the implantation of an Impella Circulatory Support System. Upon transfer to our facility it was discovered that during transport, the Impella device had migrated through the left ventricle. She was emergently taken to the operating room where the Impella was surgically removed and biventricular support devices were placed...
September 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28930049/experience-with-the-syncardia-total-artificial-heart-in-a-canadian-centre
#11
Anthony Nguyen, Michel Pellerin, Louis P Perrault, Michel White, Anique Ducharme, Normand Racine, Michel Carrier
BACKGROUND: The SynCardia total artificial heart (TAH) provides complete circulatory support by replacing both native ventricles. Accepted indications include bridge to transplantation and destination therapy. We review our experience with TAH implantation during a period when axial flow pump became available. METHODS: We retrospectively analyzed the demographics, clinical characteristics and survival of all patients receiving the TAH. RESULTS: From September 2004 to November 2016, 13 patients (12 men, mean age 45 ± 13 yr) received the TAH for refractory cardiogenic shock secondary to idiopathic (56%) or ischemic (17%) cardiomyopathy and to other various causes (33%)...
October 1, 2017: Canadian Journal of Surgery. Journal Canadien de Chirurgie
https://www.readbyqxmd.com/read/28928991/stress-cardiomyopathy-managed-with-extracorporeal-support-after-self-injection-of-epinephrine
#12
Bourenne Jeremy, Fresco Raphaëlle, Kerbaul François, Michelet Pierre, Gainnier Marc
A 28-year-old man was admitted to the ICU for self-injection of Epinephrine. This injection resulted in the rapid development of a catecholamine-induced cardiomyopathy (inverted Takotsubo) with a severe cardiogenic shock. The importance of ventricular dysfunction required the implementation of a temporary arteriovenous circulatory support until the recovery of myocardial stunning. This case allows redefining the role of circulatory assistance during cardiotropic agents intoxication.
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28926736/national-early-warning-score-news-at-icu-discharge-can-predict-early-clinical-deterioration-after-icu-transfer
#13
Supattra Uppanisakorn, Rungsun Bhurayanontachai, Jaruwan Boonyarat, Julawan Kaewpradit
OBJECTIVE: This study aims to determine the ability of the National Early Warning Score at ICU discharge (NEWSdc) to predict the development of clinical deterioration within 24h. METHODS: A prospective observational study was conducted. The NEWS was immediately recorded before discharge (NEWSdc). The development of early clinical deterioration was defined as acute respiratory failure or circulatory shock within 24h of ICU discharge. The discrimination of NEWSdc and the best cut off value of NEWSdc to predict the early clinical deterioration was determined...
September 13, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28923988/contemporary-management-of-cardiogenic-shock-a-scientific-statement-from-the-american-heart-association
#14
REVIEW
Sean van Diepen, Jason N Katz, Nancy M Albert, Timothy D Henry, Alice K Jacobs, Navin K Kapur, Ahmet Kilic, Venu Menon, E Magnus Ohman, Nancy K Sweitzer, Holger Thiele, Jeffrey B Washam, Mauricio G Cohen
Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities...
October 17, 2017: Circulation
https://www.readbyqxmd.com/read/28915214/non-hemodynamic-effects-of-catecholamines
#15
Clair Hartmann, Peter Radermacher, Martin Wepler, Benedikt Nußbaum
Circulatory shock is defined as an imbalance between tissue oxygen supply and demand, and mostly results from a loss of blood volume, cardiac pump failure, and/or reduction of vasomotor tone. The clinical hallmarks of circulatory shock are arterial hypotension and lactate acidosis. Since the degree and duration of hypotension are major determinants of outcome, vasopressor administration represents a cornerstone therapy to treat these patients. Current guidelines recommend the use of catecholamines as the drug of first choice...
October 2017: Shock
https://www.readbyqxmd.com/read/28913740/temporary-mechanical-circulatory-support-for-cardiogenic-shock
#16
REVIEW
Jean Touchan, Maya Guglin
Cardiogenic shock is a life-threatening presentation of severe heart failure with high morbidity and mortality. Given the modest increased in cardiac output and neutral/negative survival benefits with today's available inotropes (namely, dobutamine and milrinone), the use of mechanical circulatory support (MCS) has increased dramatically over the past 2 decades. In this review article, we discuss the physiologic concept, clinical evidence of benefit, and current use and indications/potential complications of the four most commonly used devices for MCS: intra-aortic balloon pump, Impella percutaneous ventricular assist device, TandemHeart, and extracorporeal membrane oxygenation (ECMO)...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28912915/gastrointestinal-bleeding-successfully-treated-using-interventional-radiology
#17
Nobuhiro Takeuchi, Masakazu Emori, Makoto Yoshitani, Junichi Soneda, Masanori Takada, Yusuke Nomura
Gastrointestinal (GI) bleeding is an emergency medical condition that leads to hemorrhagic shock or circulatory instability if left untreated. A mainstay for treating GI bleeding is endoscopic therapy; more than 90% of GI bleeding can be staunched by endoscopic hemostasis. However, patients with unstable hemodynamics or GI bleeding that cannot be controlled by endoscopy require transcatheter embolization or surgical intervention. The development of several devices and embolization agents that are used in interventional radiology (IVR) leads to safe and accessible treatment via IVR...
August 2017: Gastroenterology Research
https://www.readbyqxmd.com/read/28891162/integrating-invasive-hemodynamic-parameters-into-risk-stratification-of-acute-myocardial-infarction-and-cardiogenic-shock
#18
EDITORIAL
Gennaro Giustino, George D Dangas
A ratio of systolic blood pressure over left ventricle end-diastolic pressure (SBP/LVEDP) ≤4 identifies patients with ST-elevation myocardial infarction (STEMI) at greater risk of in-hospital mortality or that may require the use of mechanical circulatory support (MCS). The predictive performance of the SBP/LVEDP ratio was comparable to non-invasive hemodynamic parameters (the shock index and the modified shock index) and established clinical risk stratification tools (the TIMI risk score). Alongside established clinical risk factors, invasive hemodynamic parameters may help in identifying STEMI patients who may benefit from early MCS...
September 1, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28888521/impact-of-center-left-ventricular-assist%C3%A2-device-volume-on-outcomes%C3%A2-after%C3%A2-implantation-an-intermacs-analysis
#19
Jennifer A Cowger, John M Stulak, Palak Shah, Todd F Dardas, Francis D Pagani, Shannon M Dunlay, Simon Maltais, Keith D Aaronson, Ramesh Singh, Nahush A Mokadam, James K Kirklin, Christopher T Salerno
OBJECTIVES: This study examined patient outcomes after left ventricular assist device (LVAD) implantation across a range of center surgical volumes. BACKGROUND: In order for a center to qualify for reimbursement, Centers for Medicare and Medicaid Services (CMS) requires it to implant ≥10 LVADs or total artificial hearts over a 3-year period. The impact of center LVAD surgical volumes on patient outcomes has not been thoroughly scrutinized. METHODS: Center volumes were provided for 7,416 patients undergoing LVAD implantation who were enrolled in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support)...
October 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28887927/cardiac-support-emphasis-on-venoarterial-ecmo
#20
REVIEW
Christopher S King, Aviral Roy, Liam Ryan, Ramesh Singh
Major advances have been made in mechanical circulatory support in recent years. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) provides both pulmonary and circulatory support for critically ill patients with hemodynamic compromise, serving as a bridge to recovery or definitive therapy in the form of transplant or a durable ventricular assist device. In the past, VA ECMO support was used in cases of cardiogenic shock or failure to wean from cardiopulmonary bypass; however, the technology is now being applied to an ever-expanding list of conditions, including massive pulmonary embolism, cardiac arrest, drug overdose, and hypothermia...
October 2017: Critical Care Clinics
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