The Impella mechanical circulatory support (MCS) system is a catheter-based continuous flow cardiac assist device that is widely used in the treatment of cardiogenic shock in medical and surgical cardiac intensive care units. As with all forms of MCS, device-related complications remain a major concern, the incidence of which can be mitigated by adhering to a few fundamental concepts in device management. The purpose of this review is to comprehensively describe our strategy for managing, repositioning, and weaning the Impella catheter.
Double interatrial septum is an extremely rare congenital anomaly which forms a distinguished midline interatrial chamber between the two atria. The objective of this case report is to highlight this unusual anomaly and to discuss the potential complications of this condition. We report the case of a 6-year-old asymptomatic child who underwent cardiac evaluation for a soft systolic murmur eventually being diagnosed with double interatrial septum.
The utility of preoperative transthoracic echocardiogram (TTE) before hip fracture repair remains controversial. This is a retrospective chart review study of adult patients admitted with hip fractures from multiple sites, including tertiary and community hospitals, with teaching and nonteaching services. The study compared the length of stay, time to surgery, in-hospital mortality, and postoperative complications between TTE and non-TTE groups. TTE patients were risk stratified using the Revised Cardiac Risk Index to compare TTE indications according to contemporary guidelines.
Background:
Acute myocardial infarction (AMI) remains one of the most common cause for cardiogenic shock (CS). Emergent revascularization with and without mechanical support demonstrated the benefit in patients with AMI-CS, but data on the utility of pulmonary artery catheter (PAC) in patients with AMI-CS is lacking.
Methods:
We performed a retrospective study from a large healthcare system (11 hospitals) from October 1
st
2014 to October 2021. We divided the patients with AMI-CS, into two groups those who received PAC and those who did not. Propensity matched analysis was performed for baseline characteristics, comorbidities, and laboratory values to account for the underlying cofounders. The in-hospital outcome was recorded for both groups
Results
The total cohort included 2585 patients (STEMI: 797; NSTEMI: 1788). Of these 517 patients underwent PAC placement: 19.7 % of the patients in the STEMI group, and 20.4% of patients in the NSTEMI group. Mean age was similar among the PAC and the non-PAC groups (68.87 years vs 67.12 years respectively. Patients who underwent PAC had more diabetes (59.4% vs 53.1%, p=0.011), chronic kidney disease (50.9% vs45.2%, p=0.020), and coronary artery disease (77.8% vs 71.9%, p = 0.007). Overall, in-hospital mortality was lower in patients who underwent PAC and higher in patients who did not receive PAC (25.9% vs 35.9%, p<0.001) and these results remained significant after propensity matching as shown in Figure 1. Similar results were seen across all SCAI stages with improved mortality in PAC group. Overall mechanical circulatory device utilization was higher in the PAC group.
Conclusion
Our study shows that the use of PAC patients with AMI-CS was associated with improved mortality. If proven in randomized clinical trials PAC should be routinely used for all patients presenting with AMI-CS.
INTRODUCTION:Central venous catheters (CL) outside the ICU have few indications but are extremely convenient for medication administration and lab draws. This may result in provider hesitation for removal despite CL-associated blood stream infections. In this study, we assessed all CLs outside the ICU and aimed to characterize the use of inappropriate CLs outside the ICU.
METHODS:We conducted a prospective interventional study between April 4 and July 3, 2022, to assess all adult patients with non-tunneled CLs in a non-ICU setting at a large tertiary care facility. Peripherally inserted central catheters (PICC) were included. After 48 hours of placement or transfer out of the ICU with a CL, charts were audited to determine appropriateness of CL use. Appropriate indications for continued CL use included: hemodialysis (HD), chemotherapy, total parenteral nutrition (TPN), longterm antibiotics (Abx), inotrope use, and lack of IV access as a last resort. When a CL was determined to have no appropriate indication, primary teams were contacted and advised to remove CLs with follow-up every 2 days till the CL was removed. Patients who had CLs that did not have appropriate indications for ongoing use were then analyzed using descriptive statistics.
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