Background
The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications.
Methods
We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2.
Results
A total of 1644 patients with OHCA were included in this study. The patient age was 18–93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45–66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively.
Conclusions
In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.
Congenital quadricuspid aortic valve is a rare cardiac malformation with an unknown risk of infective endocarditis. We report a case of quadricuspid aortic valve complicated with infective endocarditis. A 53-year-old Japanese woman was hospitalized with leg edema and a fever of unknown origin. Corynebacterium striatum was detected in the blood culture. Echocardiography demonstrated a quadricuspid aortic valve with vegetation and severe functional regurgitation. The condition was diagnosed as a quadricuspid aortic valve with infective endocarditis, for which surgery was performed. The quadricuspid aortic valve had three equal-sized cusps and one smaller cusp (type B according to Hurwitz classification). We dissected the vegetation and infectious focus and implanted a mechanical valve. Following the case report, we review the literature.
A 66-year-old man presented with a one month history of hoarseness. Left recurrent nerve palsy and a left upper mediastinal mass were observed by an otorhinolaryngologist who referred the patient to our department. Chest computed tomography showed a superior mediastinal mass, which seemed to involve the left common carotid and left subclavian arteries from the greater curvature of the aortic arch. The innominate vein was compressed, and collateral circulation was well developed. The left upper lobe of the lung was also seemed involved. A mediastinal biopsy conducted via left thoracoscopy revealed a malignant spindle cell tumor. The mediastinum was irradiated (40 Gy), and surgical extirpation was subsequently undertaken 3 weeks later. The tumor was successfully removed without the use of extracorporeal circulation. Because only smooth muscle actin was focally but strongly expressed immunohistochemically, leiomyosarcoma was confirmed. The patient was discharged on day 14. A solitary left pleural metastasis was observed and resected 12 months after the surgery and the patient is well without further recurrence 16 months after the initial surgery.
A two-factor experiment incorporating two photoperiods (16 L:8 D and 24 L:0 D) and four feeding intervals (6, 9, 12 and 24 h) was carried out to determine the most e⁄cient feeding interval and photoperiod for striped knifejaw, Oplegnathus fasciatus. Fish were fed a commercial diet to apparent satiation for 10 weeks. Blood was collected to measure the stress indicators. Both the photoperiod and the feeding intervals had a signi¢cant e¡ect on the growth performance of striped knifejaw; however, their interaction did not produce any signi¢cant e¡ect. The ¢nal body weight, weight gain (%) and feed intake at 6-, 9-and 12-h feeding intervals under 16 L:8 D were signi¢cantly higher than those at the 24-h interval irrespective of the photoperiod (Po0.05). The speci¢c growth rate at 6, 9 and 12 h intervals of the 16 L:8 D photoperiod was signi¢cantly higher than that of the other feeding intervals, except at 12 h of the 24 L:0 D photoperiod (Po0.05). At the end of the experiment, there were no signi¢cant di¡erences in the plasma levels of cortisol, glucose and total protein observed in ¢sh exposed to di¡erent photoperiods compared with the initial levels. The results suggested that a combination of a16 L:8 D photoperiod and either of 6-,9-or 12-h intervals can be used to stimulate the growth performance in striped knifejaw.
The valve-on-valve (VOV) technique is that a mechanical valve is implanted on the sewing cuff of the previous bioprosthesis after removing degenerated leaflets. We conducted an in vitro study to determine the size-match of the valves for VOV technique. The Carpentier-Edwards pericardial (CEP) valve and Mosaic valve were used. We measured the inner diameter of the bioprosthesis after removing the leaflets. We investigated five mechanical mitral valves and two mechanical aortic valves (inverted use). The mitral valves used in this study were the ATS valve (ATS), the CarboMedics standard valve (CMS), the CarboMedics OptiForm valve (CMO), the On-X valve, and the St Jude valve (SJM). Two aortic mechanical valves, CarboMedics and St Jude Regent valves, were investigated for inverted use. After removing the tissue leaflets, the inner diameter of the Mosaic valve was 3 mm smaller than that of the CEP valve even in the same catalogue labeling size. The outer diameters of the housing of the ATS, CMS, CMO, On-X, and SJM valves of the same catalogue size (25 mm) were 25.7, 25.8, 22.0, 25.0, and 23.2 mm, respectively. SJM and CMO valves are the favorite mechanical valve for the VOV technique in terms of the profile and size-match.
The Angio-Seal arterial closure device consists of several bioabsorbable components and is used for hemostasis of arterial puncture sites. We report 3 cases of hemorrhagic and ischemic complications related to Angio-Seal use. Two cases were treated successfully by surgical removal of the device. In the third case surgical removal of the device failed and additional intervention was necessary. The unique structure of the Angio-Seal and the most likely cause of failure should be considered when treating device-related complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.