Introduction Hemolysis during pediatric extracorporeal membrane oxygenation (ECMO) is associated with increased risk for renal failure and mortality. Objectives We aim to describe risk factors for hemolysis in pediatric ECMO supported by centrifugal pumps. Methods We conducted an analysis of retrospective data collected at an academic children’s hospital from January 2017 to December 2019. Measurements and results Plasma-free hemoglobin (PFH) levels were measured daily, and hemolysis was defined as PFH>50 mg/dL. Of 46 ECMO runs over 528 ECMO days, hemolysis occurred in 23 (58%) patients over a total of 40 (8%) ECMO days. In multivariable logistic regression models, VA-ECMO (aOR=4.69, 95% CI: 1.01–21.83) and higher hemoglobin (aOR = 1.38, 95% CI: 1.06–1.81) were independently associated with hemolysis. There were also non-significant trends toward increased risk for hemolysis with higher rotational pump speed (aOR=2.39, 95% CI: 0.75–7.65), higher packed red blood cell transfusions (aOR=1.15, 95% CI: 0.99–1.34), and higher cryoprecipitate transfusions (aOR=2.01, 95% CI: 0.83–4.86). Isolated pump exchanges that were performed in 12 patients with hemolysis led to significant decreases in PFH levels within 24 h (89 vs 11 mg/dL, p<0.01). Conclusions Hemolysis is common in pediatric ECMO using centrifugal pumps. Avoidance of high pump speeds and conservative administration of blood products may help to mitigate the risk for hemolysis. Furthermore, pump exchange may be an effective first-line treatment for hemolysis.
Background: Sigmoid diverticulitis is a common abdominal disease that may require emergency treatment. The prognosis depends on the potentially dangerous complications, in particular pylephlebitis and hepatic abscess.Case Report: We report the case of a patient with sigmoid diverticulitis, due to the ingestion of a foreign body, impacted in a diverticulum, complicated by pylephlebitis and hepatic abscess. The patient was treated by endoscopic extraction of the foreign body, antibiotic therapy and anticoagulation. Evolution was favorable.
Introduction: Sex differences in COVID-19 outcomes are well-known and have been ascribed to numerous factors including age-dependent sex hormones. We hypothesize that the protective effect of female sex in hospitalized COVID-19 patients attenuates with age. Methods: We retrospectively analyzed patients who were hospitalized for COVID-19 infection at three hospitals of the Rush University System for Health (RUSH) (Chicago, IL) between March to December 2020. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, cardiac arrest, acute heart failure, and stroke. Stratified logistic regression was performed to estimate the odds ratios of these endpoints in male compared to female patients by age group (<45, 45-55, 55-65, 65-75, and ≥75 years). Results: Of 1705 patients (age 58.1±16.9 years, 54.3% male, 24.6% White) who were hospitalized for COVID-19 infection, 179 (10.5%) patients experienced in-hospital mortality and 290 (17.0%) patients experienced MACE, respectively. The incidence of these outcomes progressively increased with age in both sexes. In patients <45 years of age, there was a trend towards increased risk for in-hospital mortality (aOR 4.47; 95% CI: 0.54 - 42.38) and MACE (aOR 2.43; 95% CI: 0.97 - 6.10) in men compared to women. However, this trend attenuated with increasing age strata and there was a slight decrease in risk for in-hospital mortality (aOR 0.79; 95% CI: 0.39 - 1.58) and MACE (aOR 0.70; 95% CI: 0.38 - 1.28) among middle-aged (55-65 years of age) men compared to women. Conclusions: In this multi-hospital registry of COVID-19 patients, there was a reverse J-shaped trend in odds of in-hospital mortality and MACE in men compared to women. Female sex appeared to be an independent protective factor for adverse hospital outcomes among patients <55 years of age but not among older patients, suggesting a protective role of premenopausal sex hormones.
Introduction: Conduction System (His-Bundle, Left Bundle Branch) Pacing (CSP) for cardiac resynchronization therapy (CRT) provides more physiologic ventricular activation than right ventricular pacing. CSP has demonstrated improved outcomes in patients with cardiomyopathy. The effectiveness of CSP in patients with cancer or prior exposure to cardiotoxic agents is unknown. Methods: We retrospectively studied patients with cancer who underwent CSP for CRT from January 2018 to June 2021 at Rush University Medical Center. Changes in QRS duration, left ventricular ejection fraction (LVEF), B natriuretic peptide (BNP), and hospital admission rates pre- and post-initiating CSP were analyzed at baseline compared with one-year post CSP using student’s T-Tests. Results: Sixty-five patients with cancer underwent CSP, of which 11 had cardiomyopathy and underwent CSP for CRT. Five patients (45.5%) were female, 5 (45.5%) Caucasian, with mean age 71.2± 9.0 years. Non-Hodgkin Lymphoma (3 cases, 27.3%) was the most common cancer. Most (90.1%) patients had non-metastatic disease, 72.7% had prior chemotherapy, 54.5% were treated with cardiotoxic agents. Seven patients (63%) had a baseline left bundle branch block (LBBB). QRS duration shortened (122.3 ± 18.9 ms. vs. 153.7 ± 20.6 ms, p=0.003), LVEF increased (27.0 ± 6.2% vs. 39.0 ± 12.9 %, p=0.007), and BNP decreased (807.6 ± 1709.9 pg/ml vs. 591.4.0 ± 1079.4 pg/ml, p=0.78) (figure1). There was no change in heart failure hospitalizations (0.3 ± 0.48 admissions /person/year), at baseline vs. 1-year post-CSP. Conclusion: In this small population of patients with cancer and reduced LVEF with indications for CRT, CSP was associated with significant improvement in LVEF and QRS duration; and a non-significant decrease in BNP. The overall hospitalization rate was very low. Future studies in a larger population with a longer follow-up period are paramount to further assess this promising strategy.
Introduction: In comparison to conventional cardiac troponin (cTn), high sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). From literature review, resource utilization seems variable across institutions. This study sought to determine the effect of converting to hs-cTn on hospital resources. Hypothesis: hs-cTn is associated with overall decrease in resource utilization Methods: We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center (Chicago, IL) over the period of transition (July 6, 2021) from a cTn to hs-cTn assay using data extracted from the electronic health record. Inclusion criteria included Emergency Department (ED) encounters between January 1, 2021 and December 31, 2021 with chief complaints of “chest pain” or “dyspnea” with an associated troponin order. The primary endpoints were percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered including troponins, electrocardiograms (ECG), echocardiograms, stress tests, and coronary angiograms. Univariable comparisons of these endpoints were performed using Student’s t-test for continuous variables and Chi-square tests for binary/categorical variables. Results: A total of 5113 encounters were analyzed. hs-cTn was associated with an overall increased ED discharge in patients with negative troponin tests (44.1% vs. 29.9%, P<0.01). In terms of cardiac testing per encounter, hs-cTn compared to cTn was associated with a marginal increase in number of troponin tests (1.9 vs. 1.6, P<0.01), electrocardiograms (3.0 vs. 2.9, P=0.01), Echocardiograms (0.5 vs. 0.4, P<0.01). There was a decrease in the utilization of stress testing (0.21 vs 0.26, P<0.01). There was a trend towards increased coronary angiography per encounter (0.11 vs. 0.09, P=0.05) and an increase in total coronary angiography use during the hs-cTn period compared to cTn (227//2471 (9.2%) vs. 195/2642 (7.4%, P=0.02)) Conclusion: Transitioning from cTn to hs-cTn was associated with increased ED discharges, marginal increase in troponin tests, ECGs, echocardiograms. There was a decrease in stress testing but increase in total coronary angiography.
Introduction: Elevated soluble urokinase type plasminogen activator (suPAR) is a risk factor for renal and cardiovascular (CV) diseases in the general population. Hypothesis: We evaluated associations between suPAR and markers of subclinical cardiotoxicity in breast cancer (BCa) patients receiving standard (std) dose doxorubicin (DOX) therapy. Methods: We conducted a prospective study of patients at Rush University Medical Center who received std (≤240 mg/m2, 4 cycles) DOX-based chemotherapy for BCa between January 2017 and May 2019. We used mixed effects linear regression models to evaluate associations between suPAR and global longitudinal strain (GLS), NT-proBNP, troponin-I, and hsCRP at baseline, cycle 2 and 4 of DOX, and 3, 6, and 12 months post-DOX treatment with adjustment for baseline demographics, CV risk factors, and CV medications. Results: Of the 37 women in our study (age 47±9.3 years, 60% White, 60% left-sided BCa, and 86% adjuvant radiation therapy), the median baseline suPAR was normal at 1.83 (1.31, 3.68) ng/dL. No woman experienced clinically significant cardiotoxicity during treatment (>10% decrease in LVEF to <50%). Baseline GLS was normal (-20.2±2.3%) and the mean change in GLS following DOX therapy was +1.1%. Neither baseline suPAR nor suPAR levels during treatment were associated with GLS, NT-proBNP, hsCRP, and troponin-I (all p<0.05). Surrogate biomarkers of cardiotoxicity such as troponin-I and hsCRP were not associated with GLS (p<0.05) while NT-proBNP was negatively associated with GLS with marginal significance (p=0.04). Conclusions: In patients receiving std DOX treatment for BCa ± radiation therapy, there was minimal subclinical cardiotoxicity as evidenced by minimal changes in GLS and lack of associations between cardiac biomarkers and GLS. Furthermore, suPAR was not associated with any of these markers at this std DOX dose for BCa. A normal baseline suPAR level may be associated with low risk for DOX-associated cardiotoxicity.
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