This is an excellent article on the feasibility of offering Veno Arterial ECMO in outlying community hospitals for Refractory Cardiogenic Shock (RCS). The Authors review a four year time period and describe assessing 104 patients of whom 87 were deemed eligible for V-A ECMO therapy.
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Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program)
December 1, 2014
November 25, 2014
In a retrospective review of 45 cases where patients were placed on VV ECMO, investigators from Seoul performed a multivariate analysis of pre-ECMO risk factors that might be predictive of an unsuccessful ECMO wean. Notably, successful weaning from ECMO was only 46%, and overall survival was only 18%.
November 10, 2014
The authors explored a sample of Medicare patients who survived sepsis during hospitalization to assess the impact of afib developing during sepsis on long-term outcomes. Of nearly 139,000 sepsis survivors, 7% had new onset afib during sepsis. Of those pts, 55% were found to have afib after hospitlization. New onset afib during sepsis was associat
October 9, 2014
A well done video describing radial artery line placement aided by US.
October 9, 2014
This randomized trial investigated two different thresholds for triggering transfusion in patients with septic shock: 9 g/dL or 7 g/dL. The lower threshold group received a median of 1 unit of blood compared to 4 in the higher threshold group. 90 day mortality rates and other morbidity were similar between the groups.
Effect of Fenoldopam on Use of Renal Replacement Therapy Among Patients With Acute Kidney Injury After Cardiac Surgery
September 29, 2014
This randomized double-blind multicenter study involving 667 pts evaluated the utility of IV fenoldopam in reducing the rate of renal replacement therapy for patients undergoing cardiac surgery who exhibit postoperative acute kidney injury. Fenoldopam did not importantly reduce the need for renal replacement therapy or 30 day mortality. Its use was
August 25, 2014
This interesting overview points out the negative effects of adrenaline on outcomes in a number of observational and randomized studies of patients experiencing cardiac arrest. The author recommends using Vasopressin after the first dose of adrenaline during resuscitation from cardiac arrest.
August 11, 2014
In an effort to identify clinical findings associated with deterioration and mortality after PE, the authors prospectively monitored 298 pts admitted through the ED with documented PE. 34% of pts experienced clinical deterioration, which was associated with hypotension, hypoxia, residual DVT, CAD, and right heart strain on echocardiogram. In contra
High-Protein Enteral Nutrition Enriched With Immune-Modulating Nutrients vs Standard High-Protein Enteral Nutrition and Nosocomial Infections in the ICU
August 6, 2014
This prospective trial from 14 ICUs in northern Europe evaluated the potential benefit of adding immune-modulating nutrients (IMHP) to standard enteral nutrition in reducing infectious complications in ventilated patients. The addition of IMHP did not alter the incidence of infectious complications, but was associated with much worse 6 month surviva
Hospital Variation in Mortality From Cardiac Arrest After Cardiac Surgery: An Opportunity for Improvement?
August 5, 2014
This study investigated failure to rescue from cardiac arrest after cardiac surgery in a data set of nearly 80,000 pts in order to determine whether variability in this outcome might provide an opportunity for quality improvement in low-performing hospitals. The overall failure to rescue rate was 60% among over 4,100 pts who experienced postoperativ