ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Surgical technique for the implantation of mechanical circulatory support with the Impella 5.0 pump in a patient with post-cardiotomy cardiogenic shock

International audienc

Entrenamiento basado en simulación durante el grado para el diagnóstico de estenosis mitral. Clínica, imágenes y toma de decisiones

Dada la importancia del conocimiento de la estenosis mitral, se desarrollan simulaciones para el entrenamiento de su diagnóstico durante el grado. Se preparan varios supuestos clínicos de alta fidelidad y diferentes niveles de dificultad y se adaptan a maniquí SimMan, incluyendo información de anamnesis, signos e imágenes reales anonimizadas. Una vez probados los casos, son utilizados en sesiones teórico-prácticas para reforzar lo aprendido en clase. Los alumnos presentan dificultades para reconocer la patología basándose en la clínica y la información recabada durante la anamnesis. No obstante, mantienen alto grado de sospecha clínica que no confirman hasta la visualización de las imágenes. El alumnado es capaz de reconocer el cuadro gracias a las imágenes complementarias, pero no de elaborar un juicio clínico previo. Creemos que se debe reforzar el reconocimiento de signos, haciendo hincapié en que las pruebas complementarias sirven para confirmar una presunción clínica que previamente han debido de elaborar ellos mismos

Venous or Arterial Thromboses after Venoarterial-Extracorporeal Membrane Oxygenation Support: Frequency and Risk Factors

International audienceBACKGROUNDAlthough venous thrombosis after venovenous–extracorporeal membrane oxygenation (ECMO) is well described, vascular complications occurring after venoarterial ECMO (VA-ECMO) removal have not yet been thoroughly described. Our aim was to evaluate the frequency of vascular (arterial and venous) complications after VA-ECMO removal and try to identify the risk factors associated with them.METHODSRetrospective analysis of data prospectively collected in 2 intensive care units was performed. Consecutive patients successfully weaned off VA-ECMO during year 1 were screened for cannula-associated deep vein thrombosis (CaDVT) or arterial complications (arterial thrombosis/stenosis) using Doppler ultrasonography.RESULTSFrom November 2018 to November 2019, a total of 107 patients with a median (interquartile range [IQR]) age of 54 (42–63) years and a median (IQR) ECMO support duration of 8 (2–5) days were successfully weaned off VA-ECMO and included. CaDVT occurred in 44 patients (41%), and arterial complications occurred in 15 (14%) (9 acute leg ischemia, 1 arteriovenous femoral fistula, and 5 late femoral stenosis). Multivariable analysis retained longer duration of ECMO support (odds ratio [OR]: 1.12 per day; 95% CI: 1.02–1.22) and infection occurring on ECMO (OR: 3.03; 95% CI: 1.14–8.03) as independent risk factors for CaDVT, whereas older age (OR: 0.97 per year; 95% CI: 0.94–0.99) and previous anti-coagulation use (OR: 0.21; 95% CI: 0.06–0.68) were protective factors for CaDVT. No risk factors for arterial complications were identified.CONCLUSIONSIn patients requiring VA-ECMO support, vascular complications occurred frequently after its removal, especially CaDVT. Arterial complications, either early leg ischemia or late arterial stenosis, were observed less often. Strategies aimed at preventing CaDVT after VA-ECMO remain to be determined

The morphologically right and left ventricles cannot be distinguished by their coronary arterial pattern.

The morphologically right and left ventricles are distinguished from each other based on their internal anatomical features, because their external (epicardial) surfaces do not appear to have any distinguishing mark for such ventricular identification. Nevertheless, ventricular identification based on epicardial characteristics, if these were possible, would be interesting to surgeons, because this would enable them to identify each ventricle rapidly upon opening the chest. This made us curious as to whether or not the two ventricles may be distinguished based on their epicardial coronary arterial patterns, because this is the most obvious epicardial ventricular feature. This idea led us to formulate the following 2 hypotheses: (i) The morphologically left ventricle is always the one that receives the higher number of the marginal arteries as compared to the morphologically right ventricle. (ii) Only the morphologically left ventricle receives the diagonal arteries from the anterior and posterior interventricular arteries. These hypotheses were tested in this anatomical observational study by examination of 98 normal and 398 congenitally malformed formaldehyde-preserved hearts encompassing most malformations, including rare ones and hearts in which 1 ventricle is hypoplastic. These examinations show that both hypotheses are false. The two ventricles cannot be distinguished from each other based on the number of marginal arteries that they receive or which one receives diagonal arteries; both ventricles may receive diagonal arteries from either or both interventricular arteries

Cardiac surgery simulation: The future of teaching in our specialty?

Introducción: La simulación como herramienta docente se está estableciendo como una prioridad en los currículos de nuestra especialidad en determinados países, principalmente anglosajones, y cada vez se están desarrollando escenarios más sofisticados y completos. Métodos: Se ha fomentado la creación de un equipo multidisciplinar con profesores de universidad, estudiantes de Medicina y médicos con el objetivo de mejorar la docencia del Grado en Medicina y valorar su potencial exportación a la formación especializada en Cirugía Cardiovascular. Resultados: Los alumnos de Medicina participantes demostraron una clara mejoría en la asimilación de información, así como en sus habilidades clínico-prácticas, conforme se fueron estableciendo escenarios de simulación. Del mismo modo, esta herramienta permitió una evaluación objetiva tanto de los resultados in situ como de la evolución temporal de los mismos. Conclusiones: Dado el rendimiento positivo en estudiantes de Medicina, y debido a la cada vez mayor dificultad en la formación de residentes en nuestros hospitales (cuestiones ético-legales, escasez de tiempo de formación, complejidad de casos), se debería plantear la creación de un grupo de Simulación a nivel nacional para valorar la inclusión de la misma en el currículo de la especialidad.Introduction: Simulation is becoming a powerful teaching tool of our specialty in certain countries, particularly in English-speaking ones, in which sophisticated scenarios are being increasingly developed. Methods: We have encouraged the creation of a multidisciplinary team with university professors, medical students, and physicians in order to improve teaching in the School of Medicine and to assess the potential use of the developed teaching techniques into specialised training in Cardiovascular Surgery. Results: Medical students showed a clear improvement in the assimilation of information and skills in clinical practice when they were setting up scenarios. Similarly,this tool allowed an objective assessment of the results in situ as well as over time. Conclusions: Given the positive performance by medical students, and because ofthe increasing difficulty in training residents in our hospitals (ethical and legal issues, shortage of patients, complexity of cases), Simulation groups should be created at national level to assess the inclusion of this into the curriculum of the specialt

Dietary calcium and bone density in adolescent girls and young women in Europe

The objective of this study was to investigate the association between dietary calcium intake and radial bone density among young women, over the whole range of intake and at different levels of calcium intake. The study design was a cross-sectional, observational multicenter investigation in six European countries. One thousand one hundred and sixteen healthy Caucasian girls aged 11-15 years and 526 women aged 20-23 years participated, after having been selected from larger population samples to represent a large range in calcium intake. Bone mineral density (BMD) was measured with dual- energy X-ray absorptiometry at the ultradistal and middistal radius. Calcium intake was assessed with 3-day food records. Other potential determinants of BMD were measured by anthropometry or questionnaires. Mean calcium intake among the girls varied between 609 mg/day in Italy and 1267 mg/day in Finland; intakes for women were in a similar range. After adjustment for height, weight, and age at menarche for the women, and adjustment for age, height, weight, Tanner stage, and bone area for the girls, radial BMD at both sites did not significantly vary among quartiles of calcium intakes for both age groups. In multivariate linear regression, calcium was weakly positively associated with BMD at both sites in the girls (per 100 mg of calcium: β = 0.57 mg/cm2, p = 0.03 for middistal BMD and β = 0.56 mg/cm2, p = 0.01 for ultradistal BMD). For middistal BMD, the association was observed predominantly in premenarcheal girls. The associations were no longer statistically significant after full adjustment for all determinants of BMD, except again in pre-menarcheal girls. Radial BMD in the women was not associated with calcium intake, except after full adjustment for determinants of BMD, when ultradistal BMD became inversely associated with calcium intake (per 100 mg β = -1.02, p = 0.03); this finding was due to results in one of the countries and not found in other countries. There was no evidence for a different relation between calcium and BMD at different levels of intake; although there was a positive association at calcium intake levels <600 mg/day, the interaction was not significant and there was no consistent trend over intake categories. These results do not support the hypothesis that dietary calcium is a determinant of peak BMD in European women, for a wide range of intake. This study does not provide evidence that Recommended Dietary Allowances for calcium should be increased.Chemicals/CAS: Calcium, Dietar

Simulación en cirugía cardíaca: ¿el futuro de la docencia en nuestra especialidad?

Introducción: La simulación como herramienta docente se está estableciendo como una prioridad en los currículos de nuestra especialidad en determinados países, principalmente anglosajones, y cada vez se están desarrollando escenarios más sofisticados y completos. Métodos: Se ha fomentado la creación de un equipo multidisciplinar con profesores de universidad, estudiantes de Medicina y médicos con el objetivo de mejorar la docencia del Grado en Medicina y valorar su potencial exportación a la formación especializada en Cirugía Cardiovascular. Resultados: Los alumnos de Medicina participantes demostraron una clara mejoría en la asimilación de información, así como en sus habilidades clínico-prácticas, conforme se fueron estableciendo escenarios de simulación. Del mismo modo, esta herramienta permitió una evaluación objetiva tanto de los resultados in situ como de la evolución temporal de los mismos. Conclusiones: Dado el rendimiento positivo en estudiantes de Medicina, y debido a la cada vez mayor dificultad en la formación de residentes en nuestros hospitales (cuestiones ético-legales, escasez de tiempo de formación, complejidad de casos), se debería plantear la creación de un grupo de Simulación a nivel nacional para valorar la inclusión de la misma en el currículo de la especialidad