Implementation of organ support methods to acute cardiology and its influence on patients' survival.

Akutní kardiologie se zabývá kritickými stavy, které mohou dospět do orgánových dysfunkcí a selhání. V takovém případě je nutné zahájení orgánové podpory, a to farmakologické i nefarmakologické, přístrojové. Práce se zabývá implementací metod orgánové podpory v akutní kardiologii a vlivem na přežívání kriticky nemocných. Autor zavedl a vědecky analyzoval přínos mimotělní membránové oxygenace (ECMO - extracorporeal membrane oxygenation), a to obecně u kriticky nemocných a také u podskupiny pacientů s akutním pravostranným srdečním selháním s kardiogenním šokem. Byla potvrzena použitelnost a účinnost této metody u kriticky nemocných. Dále byl hodnocen vliv mírné terapeutické hypotermie u pacientů po náhlé zástavě oběhu na přežívání a neurologický výsledek (neuroprotekce) analýzou souboru 114 úspěšně resuscitovaných nemocných. (...) Tento fakt potvrzuje klíčovou roli hemodynamického stavu na prognóze kriticky nemocného. Dále byla zavedena metoda neinvazívní umělé plicní ventilace a zahájena činnost specializované ambulance, která sleduje kriticky nemocné nejen v časné pohospitalizační fázi. Trvalé rozšiřování možností orgánové podpory je předpokladem dalšího rozvoje kardiocentra.Acute cardiology cares for critically ill patients suffering from organ dysfunctions and failures, which have to be supported by both pharmacological and non-pharmacological, device-related organ support. The thesis deals with implementation of organ support methods to acute cardiology and its influence on patients' survival. Author implemented and scientifically analyzed benefits of ECMO (extracorporeal membrane oxygenation) both in generally critically ill, and in patients with severe right ventricular failure with cardiogenic shock. (...) These findings confirm crucial role of hemodynamic status in the prognosis of the critically ill patients. Noninvasive artificial mechanical ventilation and specialized outpatient facility were also implemented for early postdischarge care for patients, who survive critical illness. Continued extending of organ support measures is a key prerequisite for further cardiac centre developement.2nd Department of Medicine - Clinical Department of Cardiology and AngiologyII. interní klinika - klinika kardiologie a angiologie 1.LF a VFN v PrazeFirst Faculty of Medicine1. lékařská fakult

Rare myxoid liposarcoma metastasis to the interventricular septum of the heart

AbstractLiposarcomas are malignant tumors of the soft tissue. Myxoid liposarcoma is the second most common subtype of these tumors in adults. It accounts for approximately 20% of all malignant soft tissue tumors [1,2]. Peak of its incidence occurs between 40 to 60 years of age with relatively indolent clinical course Matsumoto et al. (2007) [3], Cho et al. (2010) [4], Faiman et al. (2005) [5]. Typical localizations of myxoid liposarcoma comprise limbs, particularly thighs with a tendency to metastasize into extrapulmonary sites such as retroperitoneum, mediastinum, bones. Cardiac metastases are extremely rare.We present a case of a 36-year-old man with a history of recurrent myxoid liposarcoma. Primary location was in the left popliteal area. After extirpation of the tumor, metastatic tumor was subsequently revealed in the right axilla. Each surgical extirpation was followed by radiation therapy and brachytherapy. Cardiac metastasis was accidentally diagnosed with PET/CT during the staging process. The patient was asymptomatic and was admitted to our institution for further diagnostics and treatment. After confirmation of its location, the tumor was excised. Histological examination revealed myxoid liposarcoma

Extracorporeal life support in COVID-19-related acute respiratory distress syndrome: A EuroELSO international survey

Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient’s recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS

Efficacy of dapagliflozin in heart failure with reduced ejection fraction according to body mass index

Background: In heart failure with reduced ejection fraction (HFrEF), there is an “obesity paradox”, where survival is better in patients with a higher body mass index (BMI) and weight loss is associated with worse outcomes. We examined the effect of a SGLT2 inhibitor according to baseline BMI in the Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure trial (DAPA-HF). Methods and Results: BMI was examined using standard categories i.e. underweight (<18.5 kg/m2); normal weight (18.5-24.9 Kg/m2); overweight (25.0-29.9 Kg/m2); obesity class I (30.0-34.9 Kg/m2); class II (35.0-39.9 Kg/m2) and class III (≥40 Kg/m2). The primary outcome in DAPA-HF was the composite of worsening heart failure or cardiovascular death. Overall, 1348 patients (28.4%) were under/normal-weight, 1722 (36.3%) overweight, 1013 (21.4%) obesity class I and 659 (13.9%) obesity class II/III. The unadjusted hazard ratio (95% CI) for the primary outcome with obesity category 1, the lowest risk group, as reference was: under-/normal-weight 1.41 (1.16-1.71), overweight 1.18 (0.97-1.42), obesity class II/III 1.37 (1.10-1.72). Patients with class I obesity were also at lowest risk of death. The effect of dapagliflozin on the primary outcome and other outcomes did not vary by baseline BMI e.g., HR for primary outcome: under-/normal-weight 0.74 (0.58-0.94), overweight 0.81 (0.65-1.02), obesity class I 0.68 (0.50-0.92), obesity class II/III 0.71 (0.51-1.00); P for interaction=0.79. The mean decrease in weight at 8 months with dapagliflozin was 0.9 (0.7-1.1) Kg (p<0.001). Conclusion: We confirmed an “obesity survival paradox” in HFrEF. We showed that dapagliflozin was beneficial across the wide range of BMI studied. Clinical Trial Registration: ClinicalTrials.gov number NCT03036124 (https://clinicaltrials.gov/ct2/show/NCT03036124

Biomarkers of brain injury after cardiac arrest; a statistical analysis plan from the TTM2 trial biobank investigators

Background: Several biochemical markers in blood correlate with the magnitude of brain injury and may be used to predict neurological outcome after cardiac arrest. We present a protocol for the evaluation of prognostic accuracy of brain injury markers after cardiac arrest. The aim is to define the best predictive marker and to establish clinically useful cut-off levels for routine implementation. Methods: Prospective international multicenter trial within the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial in collaboration with Roche Diagnostics International AG. Samples were collected 0, 24, 48, and 72 hours after randomisation (serum) and 0 and 48 hours after randomisation (plasma), and pre-analytically processed at each site before storage in a central biobank. Routine markers neuron-specific enolase (NSE) and S100B, and neurofilament light, total-tau and glial fibrillary acidic protein will be batch analysed using novel Elecsys® electrochemiluminescence immunoassays on a Cobas e601 instrument. Results: Statistical analysis will be reported according to the Standards for Reporting Diagnostic accuracy studies (STARD) and will include comparisons for prediction of good versus poor functional outcome at six months post-arrest, by modified Rankin Scale (0–3 vs. 4–6), using logistic regression models and receiver operating characteristics curves, evaluation of mortality at six months according to biomarker levels and establishment of cut-off values for prediction of poor neurological outcome at 95–100% specificities. Conclusions: This prospective trial may establish a standard methodology and clinically appropriate cut-off levels for the optimal biomarker of brain injury which predicts poor neurological outcome after cardiac arrest

The Supreme Administrative Court of the Czechoslovak Republik - Its Formation and Development

Department of Legal HistoryKatedra právních dějinFaculty of LawPrávnická fakult

The Supreme Administrative Court of the Czechoslovak Republik - Its Formation and Development

Department of Legal HistoryKatedra právních dějinFaculty of LawPrávnická fakult

Činnost operačního střediska krajského útvaru Sboru požární ochrany

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Implementation of organ support methods to acute cardiology and its influence on patients' survival.

Acute cardiology cares for critically ill patients suffering from organ dysfunctions and failures, which have to be supported by both pharmacological and non-pharmacological, device-related organ support. The thesis deals with implementation of organ support methods to acute cardiology and its influence on patients' survival. Author implemented and scientifically analyzed benefits of ECMO (extracorporeal membrane oxygenation) both in generally critically ill, and in patients with severe right ventricular failure with cardiogenic shock. (...) These findings confirm crucial role of hemodynamic status in the prognosis of the critically ill patients. Noninvasive artificial mechanical ventilation and specialized outpatient facility were also implemented for early postdischarge care for patients, who survive critical illness. Continued extending of organ support measures is a key prerequisite for further cardiac centre developement