Hemodynamic and respiratory support in pulmonary embolism: a narrative review

Pulmonary embolism is a common and potentially fatal disease, with a significant burden on health and survival. Right ventricular dysfunction and hemodynamic instability are considered two key determinants of mortality in pulmonary embolism, which can reach up to 65% in severe cases. Therefore, timely diagnosis and management are of paramount importance to ensure the best quality of care. However, hemodynamic and respiratory support, both major constituents of management in pulmonary embolism, associated with cardiogenic shock or cardiac arrest, have been given little attention in recent years, in favor of other novel advances such as systemic thrombolysis or direct oral anticoagulants. Moreover, it has been implied that current recommendations regarding this supportive care lack enough robustness, further complicating the problem. In this review, we critically discuss and summarize the current literature concerning the hemodynamic and respiratory support in pulmonary embolism, including fluid therapy, diuretics, pharmacological support with vasopressors, inotropes and vasodilators, oxygen therapy and ventilation, and mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation and right ventricular assist devices, while also providing some insights into contemporary research gaps

Code Cancer: preliminary results

Background: Delays in medical intervention for people living with cancer negatively impact the quality of life and increase costs to the healthcare system. // Objective: To describe the “Code Cancer” project phases and their preliminary results. Methods: Seven research groups organized to: a) understand the causes of delays faced by people with cancer in Mexico, their trajectories, and associated costs; b) understand the formal and informal referral mechanisms that constitute their trajectory in the health system, and c) understand the existing and necessary infrastructure to respond to the epidemiological needs of the country. // Results: These preliminary results lay the groundwork for implementing a rapid patient referral program.// Conclusions: Evidence-based policies for early cancer diagnosis and treatment are essential to address delays in medical assistance. “Code Cancer” represents an innovative project to achieve this goal in Mexico

Código Cáncer: resultados preliminares

Antecedentes: Los retrasos en la atención de personas con cáncer impactan negativamente su calidad de vida y aumentan los costos al sistema de salud. / Objetivo: Describir las fases del proyecto Código Cáncer y sus resultados preliminares. / Métodos: Se organizaron siete grupos de investigación para: a) entender las causas de los retrasos que enfrentan las personas con cáncer en México, sus trayectorias y costos asociados; b) conocer los mecanismos de referencia formales e informales que constituyen su trayectoria en el sistema de salud, y c) entender la infraestructura existente y la necesaria para responder a las necesidades epidemiológicas del país. / Resultados: Estos resultados sientan las bases para la implementación de un programa de referencia rápida de pacientes. / Conclusión: Las políticas de diagnóstico y tratamiento oportuno del cáncer basadas en la evidencia son imprescindibles para atender los retrasos en la atención. Código Cáncer representa un proyecto innovador para lograr este objetivo en México