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Coronary Care Unit

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63 papers 25 to 100 followers
Jordan B Strom, Yuansong Zhao, Changyu Shen, Mabel Chung, Duane S Pinto, Jeffrey J Popma, David J Cohen, Robert W Yeh
BACKGROUND: Limited knowledge exists on inter-hospital variation in the utilization of short-term, nondurable mechanical circulatory support (MCS) for myocardial infarction (MI) complicated by cardiogenic shock (CS). METHODS AND RESULTS: Hospitalizations for MI with CS in 2014 in a nationally representative all-payer database were included. The proportion of hospitalizations for MI with CS using MCS (MCS ratio) and in-hospital mortality were evaluated. Hospital characteristics and outcomes were compared across quartiles of MCS usage...
January 2019: Circulation. Cardiovascular Interventions
William Toppen, Elizabeth Aquije Montoya, Stephanie Ong, Daniela Markovic, Yuhan Kao, Xueqing Xu, Alan Chiem, Maxime Cannesson, David Berlin, Igor Barjaktarevic
PURPOSE: Passive leg raise (PLR), in combination with technologies capable of capturing stroke volume changes, has been widely adopted in the management of shock. However, dedicated evaluation of safety, feasibility, and receptiveness of patients and nursing staff to PLR maneuver is missing. METHODS: A noninterventional, prospective trial recruited adult patients with onset of undifferentiated shock within 24 hours with persistent vasopressor requirements despite fluid resuscitation...
December 20, 2018: Journal of Intensive Care Medicine
Vincent Auffret, Yves Cottin, Guillaume Leurent, Martine Gilard, Jean-Claude Beer, Amer Zabalawi, Frédéric Chagué, Emanuelle Filippi, Damien Brunet, Jean-Philippe Hacot, Philippe Brunel, Mourad Mejri, Luc Lorgis, Gilles Rouault, Philippes Druelles, Jean-Christophe Cornily, Romain Didier, Emilie Bot, Bertrand Boulanger, Isabelle Coudert, Aurélie Loirat, Marc Bedossa, Dominique Boulmier, Maud Maza, Marielle Le Guellec, Rishi Puri, Marianne Zeller, Hervé Le Breton
Aims: To derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS). Methods and results: In all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire Régional Breton sur l'Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d'Or (RICO) constituted the external validation cohort...
June 7, 2018: European Heart Journal
S Magder
Measurement of arterial pressure is one of the most basic elements of patient management. Arterial pressure is determined by the volume ejected by the heart into the arteries, the elastance of the walls of the arteries, and the rate at which the blood flows out of the arteries. This review will discuss the three forces that determine the pressure in a vessel: elastic, kinetic, and gravitational energy. Emphasis will be placed on the importance of the distribution of arterial resistances, the elastance of the walls of the large vessels, and critical closing pressures in small arteries and arterioles...
October 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
Greg S Martin, Paul Bassett
PURPOSE: Guidelines recommend crystalloids for fluid resuscitation in sepsis/shock and switching to albumin in cases where crystalloids are insufficient. We evaluated hemodynamic response to crystalloids/colloids in critically ill adults. MATERIALS AND METHODS: The primary research question was: "Are crystalloids sufficient for volume replacement in severe indications (intensive care unit [ICU]/critical illness)?" Randomized, controlled trials (RCTs) were identified using PubMed and EMBASE, and screened against predefined inclusion/exclusion criteria...
November 30, 2018: Journal of Critical Care
Jasmeet Soar, Michael W Donnino, Ian Maconochie, Richard Aickin, Dianne L Atkins, Lars W Andersen, Katherine M Berg, Robert Bingham, Bernd W Böttiger, Clifton W Callaway, Keith Couper, Thomaz Bittencourt Couto, Allan R de Caen, Charles D Deakin, Ian R Drennan, Anne-Marie Guerguerian, Eric J Lavonas, Peter A Meaney, Vinay M Nadkarni, Robert W Neumar, Kee-Chong Ng, Tonia C Nicholson, Gabrielle A Nuthall, Shinichiro Ohshimo, Brian J O'Neil, Gene Yong-Kwang Ong, Edison F Paiva, Michael J Parr, Amelia G Reis, Joshua C Reynolds, Giuseppe Ristagno, Claudio Sandroni, Stephen M Schexnayder, Barnaby R Scholefield, Naoki Shimizu, Janice A Tijssen, Patrick Van de Voorde, Tzong-Luen Wang, Michelle Welsford, Mary Fran Hazinski, Jerry P Nolan, Peter T Morley
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the second annual summary of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations that includes the most recent cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation. This summary addresses the role of antiarrhythmic drugs in adults and children and includes the Advanced Life Support Task Force and Pediatric Task Force consensus statements, which summarize the most recent published evidence and an assessment of the quality of the evidence based on Grading of Recommendations, Assessment, Development, and Evaluation criteria...
December 2018: Resuscitation
Edward Hong, Tariq Naseem
The Impella (Abiomed, Danvers, MA) is a minimally invasive transvalvular left ventricular assist device (LVAD) that effectively unloads the left ventricle (LV), especially in patients with ventricular arrhythmias in the setting of a venous-arterial extracorporeal membrane oxygenator (VA ECMO).1,2 Utilization of the Impella device has increased significantly in the last few years for high-risk percutaneous coronary intervention and cardiogenic shock because of its relatively easy implantation in the catheterization lab and the operating room...
September 27, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Tobias Loehn, William W O'Neill, Bjoern Lange, Christian Pfluecke, Tina Schweigler, Johannes Mierke, Nadine Waessnig, Adrian Mahlmann, Akram Youssef, Uwe Speiser, Ruth H Strasser, Karim Ibrahim
BACKGROUND: The use of percutaneous left ventricular assist devices in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) is evolving. The aim of the study was to assess the long-term outcome of patients with AMICS depending on early initiation of Impella CP® support prior to a percutaneous coronary intervention (PCI). METHODS: We retrospectively reviewed all patients who underwent PCI and Impella CP® support between 2014 and 2016 for AMICS at our institution...
November 20, 2018: European Heart Journal. Acute Cardiovascular Care
Marina Pieri, Tania Sorrentino, Michele Oppizzi, Giulio Melisurgo, Rosalba Lembo, Antonio Colombo, Alberto Zangrillo, Federico Pappalardo
OBJECTIVES: Aim of the study was to assess in-hospital survival rate and the degree of myocardial recovery after MCS treatment (IABP or IMPELLA) at discharge and at 6 months in patients with AMI-CS and planned early percutaneous revascularization. BACKGROUND: All studies on MCS for acute myocardial infarction related cardiogenic shock (AMI-CS) focused on its impact on in-hospital mortality; however, few data about its role on myocardial recovery are available. METHODS: Retrospective study on 64 patients: 36 patients (56%) received IABP and 28 (44%) Impella 2...
November 20, 2018: Journal of Interventional Cardiology
Caroline Sindet-Pedersen, Morten Lamberts, Laila Staerk, Anders Nissen Bonde, Jeffrey S Berger, Jannik Langtved Pallisgaard, Morten Lock Hansen, Christian Torp-Pedersen, Gunnar H Gislason, Jonas Bjerring Olesen
BACKGROUND: The optimal treatment strategy when combining antiplatelets with oral anticoagulants in patients with atrial fibrillation (AF) and myocardial infarction (MI) or undergoing percutaneous coronary intervention (PCI) is unknown. OBJECTIVES: The authors investigated the risk of bleeding, ischemic stroke, MI, and all-cause mortality associated with direct oral anticoagulants (DOACs) compared with vitamin K antagonists (VKAs) in combination with aspirin, clopidogrel, or both in patients with AF following MI and/or PCI...
October 9, 2018: Journal of the American College of Cardiology
Srijan Tandukar, Paul M Palevsky
Continuous renal replacement therapy (CRRT) is commonly used to provide renal support for critically ill patients with acute kidney injury, particularly patients who are hemodynamically unstable. A variety of techniques that differ in their mode of solute clearance may be used, including continuous venovenous hemofiltration with predominantly convective solute clearance, continuous venovenous hemodialysis with predominantly diffusive solute clearance, and continuous venovenous hemodiafiltration, which combines both dialysis and hemofiltration...
September 25, 2018: Chest
Thomas F Lüscher
No abstract text is available yet for this article.
September 21, 2018: European Heart Journal
Carlos L Alviar, P Elliott Miller, Dorothea McAreavey, Jason N Katz, Burton Lee, Brad Moriyama, Jeffrey Soble, Sean van Diepen, Michael A Solomon, David A Morrow
Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulatory support. Noninvasive PPV, when appropriately applied to selected patients, may reduce the need for invasive mechanical PPV and improve survival...
September 25, 2018: Journal of the American College of Cardiology
Lukas Martin, Matthias Derwall, Sura Al Zoubi, Elisabeth Zechendorf, Daniel A Reuter, Chris Thiemermann, Tobias Schuerholz
Septic cardiomyopathy is a key feature of sepsis-associated cardiovascular failure. Despite the lack of consistent diagnostic criteria, patients typically exhibit ventricular dilatation, reduced ventricular contractility, and/or both right and left ventricular dysfunction with a reduced response to volume infusion. Although there is solid evidence that the presence of septic cardiomyopathy is a relevant contributor to organ dysfunction and an important factor in the already complicated therapeutic management of patients with sepsis, there are still several questions to be asked: Which factors/mechanisms cause a cardiac dysfunction associated with sepsis? How do we diagnose septic cardiomyopathy? How do we treat septic cardiomyopathy? How does septic cardiomyopathy influence the long-term outcome of the patient? Each of these questions is interrelated, and the answers require a profound understanding of the underlying pathophysiology that involves a complex mix of systemic factors and molecular, metabolic, and structural changes of the cardiomyocyte...
August 29, 2018: Chest
Alex Calhoun
Extracorporeal membrane oxygenation (ECMO) is used for both cardiac and pulmonary failure when conventional measures are no longer substantial in supporting life. ECMO is not a permanent device. It is used as a temporary measure to allow the lungs and heart, as well as other organs to recover. If recovery is not possible, it may also be used as a bridge to a more permanent device such as the left ventricular assist device or heart or lung transplantation. This is a detailed description of the differences between venovenous ECMO and venoarterial ECMO and the nursing care that is associated with the two...
October 2018: Critical Care Nursing Quarterly
Christopher Newell, Scott Grier, Jasmeet Soar
After cardiac arrest a combination of basic and advanced airway and ventilation techniques are used during cardiopulmonary resuscitation (CPR) and after a return of spontaneous circulation (ROSC). The optimal combination of airway techniques, oxygenation and ventilation is uncertain. Current guidelines are based predominantly on evidence from observational studies and expert consensus; recent and ongoing randomised controlled trials should provide further information. This narrative review describes the current evidence, including the relative roles of basic and advanced (supraglottic airways and tracheal intubation) airways, oxygenation and ventilation targets during CPR and after ROSC in adults...
August 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
Raphaël P Martins, Erwan Flecher, Solène Le Pennec-Prigent, Vincent Galand
No abstract text is available yet for this article.
August 24, 2018: Revista Española de Cardiología
Elena Puerto, Ana Viana-Tejedor, Manuel Martínez-Sellés, Laura Domínguez-Pérez, Guillermo Moreno, Roberto Martín-Asenjo, Héctor Bueno
BACKGROUND: Reperfusion therapy led to an important decline in mortality after ST-segment elevation myocardial infarction (STEMI). Because the rate of cardiogenic shock has not changed dramatically, the authors speculated that a reduction in the incidence or fatality rate of mechanical complications (MCs), the second cause of death in these patients, could explain this decrease. OBJECTIVES: This study sought to assess time trends in the incidence, management, and fatality rates of MC, and its influence on short-term mortality in old patients with STEMI...
August 28, 2018: Journal of the American College of Cardiology
Holger Thiele, Ibrahim Akin, Marcus Sandri, Suzanne de Waha-Thiele, Roza Meyer-Saraei, Georg Fuernau, Ingo Eitel, Peter Nordbeck, Tobias Geisler, Ulf Landmesser, Carsten Skurk, Andreas Fach, Alexander Jobs, Harald Lapp, Jan J Piek, Marko Noc, Tomaž Goslar, Stephan B Felix, Lars S Maier, Janina Stepinska, Keith Oldroyd, Pranas Serpytis, Gilles Montalescot, Olivier Barthelemy, Kurt Huber, Stephan Windecker, Lukas Hunziker, Stefano Savonitto, Patrizia Torremante, Christiaan Vrints, Steffen Schneider, Uwe Zeymer, Steffen Desch
BACKGROUND: Among patients with acute myocardial infarction, cardiogenic shock, and multivessel coronary artery disease, the risk of a composite of death from any cause or severe renal failure leading to renal-replacement therapy at 30 days was found to be lower with percutaneous coronary intervention (PCI) of the culprit lesion only than with immediate multivessel PCI. We evaluated clinical outcomes at 1 year. METHODS: We randomly assigned 706 patients to either culprit-lesion-only PCI or immediate multivessel PCI...
November 1, 2018: New England Journal of Medicine
Nicolas Meneveau, Benoit Guillon, Benjamin Planquette, Gaël Piton, Antoine Kimmoun, Lucie Gaide-Chevronnay, Nadia Aissaoui, Arthur Neuschwander, Elie Zogheib, Hervé Dupont, Sebastien Pili-Floury, Fiona Ecarnot, François Schiele, Nicolas Deye, Nicolas de Prost, Raphaël Favory, Philippe Girard, Mircea Cristinar, Alexis Ferré, Guy Meyer, Gilles Capellier, Olivier Sanchez
Aims: The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results: From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy)...
December 14, 2018: European Heart Journal
2018-08-28 15:19:36
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