Early extracorporeal CPR for refractory out-of-hospital cardiac arrest

BACKGROUNDExtracorporeal cardiopulmonary resuscitation (CPR) restores perfusion and oxy-genation in a patient who does not have spontaneous circulation. The evidencewith regard to the effect of extracorporeal CPR on survival with a favorable neu-rologic outcome in refractory out-of-hospital cardiac arrest is inconclusive.METHODSIn this multicenter, randomized, controlled trial conducted in the Netherlands, weassigned patients with an out-of-hospital cardiac arrest to receive extracorporealCPR or conventional CPR (standard advanced cardiac life support). Eligible patientswere between 18 and 70 years of age, had received bystander CPR, had an initialventricular arrhythmia, and did not have a return of spontaneous circulationwithin 15 minutes after CPR had been initiated. The primary outcome was sur-vival with a favorable neurologic outcome, defined as a Cerebral PerformanceCategory score of 1 or 2 (range, 1 to 5, with higher scores indicating more severedisability) at 30 days. Analyses were performed on an intention-to-treat basis.RESULTSOf the 160 patients who underwent randomization, 70 were assigned to receiveextracorporeal CPR and 64 to receive conventional CPR; 26 patients who did notmeet the inclusion criteria at hospital admission were excluded. At 30 days, 14 pa-tients (20%) in the extracorporeal-CPR group were alive with a favorable neuro-logic outcome, as compared with 10 patients (16%) in the conventional-CPR group(odds ratio, 1.4; 95% confidence interval, 0.5 to 3.5; P = 0.52). The number of seri-ous adverse events per patient was similar in the two groups.CONCLUSIONSIn patients with refractory out-of-hospital cardiac arrest, extracorporeal CPR andconventional CPR had similar effects on survival with a favorable neurologic out-come. (Funded by the Netherlands Organization for Health Research and Develop-ment and Maquet Cardiopulmonary [Getinge]; INCEPTION ClinicalTrials.govnumber, NCT03101787.)Cardiolog

De Winter Electrocardiographic Pattern Related with a Non-Left Anterior Descending Coronary Artery Occlusion

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Management of incidentally diagnosed pulmonary artery dissection in patients with pulmonary arterial hypertension

Pulmonary artery dissection is a rare entity, usually discovered post-mortem. In recent years, reported cases of living patients with a pulmonary artery dissection are growing and represent a challenging situation for clinicians.Cardiolog

Left Main Extrinsic Compression in Pulmonary Arterial Hypertension From Identification to Percutaneous Coronary Intervention Optimization

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Microcatheters: A valuable tool in the presence of a challenging coronary anatomy in the setting of acute coronary interventions. Case report and mini review

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"Level Crossroads" A Venous Graft Compressing a Left Internal Mammary Graft Presenting as Myocardial Infarction

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"Level Crossroads" A Venous Graft Compressing a Left Internal Mammary Graft Presenting as Myocardial Infarction

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Association Between Flow Impairment in Dominant Coronary Atrial Branches and Atrial Arrhythmias in Patients With ST-Segment Elevation Myocardial Infarction

Objectives: The impact of atrial ischemia in the occurrence of atrial arrhythmiasmay vary based on the amount of jeopardized myocardium. We sought to determine the association between coronary flow impairment in dominant coronary atrial branches (CAB) and atrial arrhythmias at 1-year follow-up in ST-segment elevation myocardial infarction (STEMI) patients.Methods: Patients with STEMI involving the right or circumflex coronary artery were included. Dominant CAB was defined as the most developed CAB. Patients were followed-up during 1 year, including 24-h Holter ECG at 3 and 6months. Atrial arrhythmiaswere defined as atrial fibrillation/flutter, atrial tachycardia (>= 3 consecutive supraventricular ectopic beats) and excessive supraventricular ectopic activity (>30 supraventricular beats/h or runs >= 20 beats).Results: A dominant CAB was identified in 897 of 900 patients STEMI (age 61 +/- 12 years, 79% male). TIMI flow b 3 at the dominant CAB was present in 69 (8%) patients. Compared to those with dominant CAB preserved flow, patients with dominant CAB flow impairment presented with higher levels of troponin T (3.9 [2.2-8.2] vs. 3.1 [1.3-5.8], P= 0.008)and higher rates of atrial tachycardia at 3months (68% vs. 37%, P= 0.007) and more supraventricular ectopic beats both at 3 months (58 [21-235] vs. 33 [12-119], P = 0.02) and at 6 months (62 [24-156] vs. 32 [12-115]; P = 0.04) on 24-h Holter ECG. Age and an impaired coronary flow at the dominant CAB were independently related to a higher risk of developing atrial arrhythmias at 1-year follow-up.Conclusion: Dominant CAB flow impairment is infrequent and is associatedwith the occurrence of atrial arrhythmias, in the form atrial tachycardia and supraventricular ectopic beats, at follow-up. (C) 2020 Elsevier Inc. All rights reserved.Cardiolog

Benefits of using rotational versus conventional coronary angiography in clinical practice

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Extracorporeal cardiopulmonary resuscitation in a patient with severe lactic acidosis: hope for the nearly dead

We present the case of a 45-year-old patient who was brought to our emergency department with an out-of-hospital cardiac arrest. The patient arrived 45 minutes after collapse due to ventricular fibrillation. The initial rhythm at arrival to the emergency department was asystole. His laboratory results showed profound lactic acidosis (lactate of 21 mmol/l and pH of 6.6). Time to arrival, rhythm at presentation and the observed lactic acidosis were all interpreted as prognostic signs of a poor outcome but, despite that, it was decided to treat the patient with extracorporeal cardiopulmonary resuscitation (ECPR). Subsequently percutaneous coronary intervention was performed. In contrast to the poor prognosis, the patient was discharged on day 6 with no discernible neurological deficit. This case illustrates that despite biochemical data suggesting profound tissue ischaemia/hypoxia, the outcome of ECPR may be excellent. Such data cannot be reliably used as a single indicator to decide whether or not ECPR should be initiated.Cardiolog