Cardiac Failure Patients Research Articles

Predictive role of frailty and malnutrition in rehospitalisation of cardiac failure patients: A literature review.

Frailty and malnutrition are two conditions that are frequently present in cardiac failure patients that eventually contribute to hospitalisation and recurrent admissions. Malnutrition and frailty are interrelated and a predictive indicator of hospitalisations and subsequent readmissions that worsen the prognosis of cardiac failure patients. Research does not typically measure both nutritional status and frailty together in cardiac failure patients, and they are not even considered when planning and implementing the interventions. The life quality can be improved by early identification of frailty secondary to malnutrition and timely nutritional interventions. Rehospitalisations after discharge due to these conditions significantly increase the risk of death which can be avoided. The current narrative review was planned to highlight frailty and malnutrition as predictive indicators of hospitalisations and subsequent readmissions. Attempts to reduce the social and economic burden owing to these conditions in cardiac failure patients have emerged as a major public health priority worldwide, particularly in the developing countries.

Is there a role for extracorporeal membrane oxygenation in children with acute liver failure? A retrospective analysis of the Extracorporeal Life Support Organization Registry.

Our results suggest that the use of ECMO for the management of respiratory and cardiac failure in patients with PALF should be considered with caution and that further research is needed to understand its role in this specific high-risk population. • Pediatric acute liver failure (PALF) is a clinical syndrome associated with significant morbidity and mortality. • Data on the use of extracorporeal membrane oxygenation (ECMO) in the context of PALF are scarce and controversial. • ECMO to manage acute respiratory and/or cardiac failure in the context of PALF should be considered with caution. • Bleeding and thrombotic complications in children with acute liver failure receiving ECMO are similar to the ones reported in the general pediatric population.

Clinical and laboratory profile, disease activity and outcome of childhood systemic lupus erythematosus - A retrospective study in a tertiary care hospital in Assam

Background: Systemic lupus erythematosus in children (cSLE) represents 10-20% of all cases of SLE. However, this is still underreported from Assam. In this study, we report our experience with 25 patients of cSLE over the last 3.5 years. Materials and methods: This retrospective study was carried out at the Department of Pediatrics, Gauhati Medical College and Hospital, Guwahati, Assam. Data of patients with cSLE in the records of pediatric rheumatology and immunodeficiency clinic from April 2018 to October 2021 were collected and analysed. Results: In our cohort, the median age at presentation was 10 years (range, 4.6-14 years). The female-to-male ratio was 7:1. Hematological involvement, 21 (84%) was the most common manifestation followed by cutaneous, 19 (76%), and renal involvement, 17 (68%). Five patients also had associated HbE hemoglobinopathy. We had performed renal biopsy in 12/17 patients. Class IV lupus nephritis was the most common type in our patients. Twenty-four out of 25 patients had active disease at the time of the first presentation. There were four deaths in our cohort including two deaths that occurred due to congestive cardiac failure in patients with suspected myocarditis. Seventeen patients in our cohort had completed a median of 10 months (range, 2 – 30 months) follow-up and 6/9 biopsy-proven proliferative nephritis were in remission after a median of 9.5 months (range, 2-27 months) follow-up. Conclusion: Hematological involvement was the commonest manifestation in cSLE at our center. The majority of patients with proliferative LN were in remission with standard treatment. Keywords: hemoglobin E; lupus nephritis; myocarditis; vasculitis

Preoperative right ventricular strain as an early predictor of perioperative cardiac failure in patients undergoing mitral surgery: An exploratory study.

This study's primary purpose was to demonstrate the correlation of preoperative right ventricular free-wall longitudinal strain (RVFWLS) and pre-/postsurgical variation in strain (delta strain) with the clinical and echocardiographic diagnosis of right ventricular dysfunction. Its secondary purpose was to determine the correlation of RVFWLS and delta strain with length of stay (LOS) in the intensive care unit (ICU), ventilation days, trend of natriuretic peptide test. (NT-proBNP) and lactate in the first 48 h, incidence of acute renal failure, and 28-day mortality. Prospective observational study. Cardio-thoracic and Vascular Anaesthesia Department and ICU of the University Hospital Integrated Trust of Verona. Patients scheduled for mitral surgery. None. All clinical and transoesophageal echocardiographic (TEE) parameters were collected at baseline, before surgery (T1) and at admission in the ICU postsurgery (T2). During the postoperative period, the clinical and echocardiographic diagnoses of right, left, or biventricular dysfunction were evaluated. TEE parameters were evaluated by a cardiologist offline. The patients were divided into two subgroups according to the development of any type of ventricular dysfunction. No statistically significant differences emerged between the two groups. According to a logistic regression model, a T1-RVFWLS value of -15% appeared to predict biventricular dysfunction (sensitivity: 100%; specificity: 91.3%). No correlation between T1- or T2-RVFWLS and creatinine, hours of ventilation or ICU LOS was found. Our study introduces a new parameter that could be used in perioperative evaluations to identify patients at risk of postoperative biventricular dysfunction.

Jellyfish stings‐induced cardiac failure was ameliorated through AAG‐mediated glycogen‐driven ATP production

AbstractThis article published in Early View in error. The article is under legal issues and the content is temporarily unavailable.4 April 2024

Effectiveness of Dapagliflozin in Reducing Incidence of Worsening Heart Failure Events among patients with Reduced Ejection Fraction

Background: Sodium–glucose co-transporter 2 (SGLT2) inhibitors are the groups of oral hypoglycemics that decreases the worse events among cardiac patients of chronic heart failure. Aim: To assess the effectiveness of Dapagliflozin in reducing the incidence of worsening heart failure events among chronic heart failure patients. Study design: Randomized controlled trial. Methodology: This study enrolled 480 cardiac patients with mildly reduced ejection fraction. This study was held at Punjab Institute of Cardiology. All patients received dapagliflozin 10mg once daily or matching placebo, in addition to usual therapy for four weeks. The data was entered and analyzed in SPSS 25. Independent sample t-test was used to compare the mean age and body mass index between two groups. Chi square test was used to compare gender and hypertension with primary composite. Results: There were 138(57.5%) males in Dapagliflozin group and 131(54.6%) males in placebo group. Dapagliflozin demonstrated significant benefits compared to placebo, as evidenced by lower rates of the primary composite outcome (15.8% vs. 23.3%, p = 0.038), hospitalization for heart failure or an urgent visit (10.4% vs. 20.0%, p = 0.003). Practical Implication: Chronic heart failure with mildly reduced ejection fraction is a major problem in modern era. Present study will highlight the effect of oral hypoglycemic, dapagliflozin, in reducing worse cardiovascular events among chronic heart failure patients. As there is a lack of local literature review on this health issue so this study added information to existing literature and add new dimensions in its treatment. Conclusion: It was concluded that dapagliflozin reduced worsening of cardiac events among heart failure patients with mildly reduced ejection fraction thus this drug is effective treatment option among cardiac failure patients in reducing hospitalization. Keywords: Heart Failure, Reduced Ejection Fraction, Effectiveness, Urgent Visits and Hospitalization

Safety of Dapagliflozinin Reducing Cardiac Events and Deaths among NYHA Class II and III Cardiac Failure Patients.

Background: In last few decades, a global transition in incidence of heart failure with reduced ejection fraction from hypertension and valvular heart disease to coronary artery disease has taken place. Aim: To assess the safety of Dapagliflozin in reducing the cardiac events and deaths among class II and class III heart failure patients. Study design: Randomized controlled trial. Methodology: Cardiac patients (n=480) who belonged from class II and III with mild to moderate reduced ejection fraction were added in this study. This study was held at Cardiology Department at Mayo Hospital. All patients received sodium–glucose co-transporter-2 (SGLT2) inhibitors at a dose of 10mg once daily or matching placebo, in addition to usual therapy for eight weeks. SPSS-v25 analyzed the entered data. Mean ± SD presented age, blood pressure and eGFR level. Chi square test was used to compare the gender, NYHA class, primary composite outcome, and cardiovascular death. Results: Dapagliflozin showed lower rates of the primary composite outcome (15.8% vs. 23.3%, p = 0.038). There was no statistically significant difference in cardiovascular death between both groups (5.8% vs. 8.8%, p = 0.219). Practical Implication: Due to lack of research culture in our setups, common health issue like chronic heart failure remained clandestine. Present study highlighted the role of oral dapagliflozin in reducing worse cardiovascular events and deaths among NHY class II and III heart failure patients. Conclusion: It was concluded that dapagliflozin showed significant reductions in various cardiovascular events and deaths compared to placebo thus highlighting its potential as a beneficial intervention in our population. Keywords: Heart Failure, Reduced Ejection Fraction, NYHA Classification, Urgent Visits and Cardiac deaths.

Impact of atrial fibrillation on mortality and non-fatal cardiovascular outcomes in 152 638 patients admitted with congestive cardiac failure: a statewide population-linkage study

Abstract Background Congestive cardiac failure (CCF) and atrial fibrillation (AF) frequently co-exist, cause and exacerbate each other. Prior studies on the impact of AF in CCF patients yielded mixed findings. Purpose This study aims to examine the impact of AF on long-term outcomes including MACE (major adverse cardiovascular events defined as all-cause mortality and major cardiovascular outcomes including myocardial infarction, ischaemic stroke, CCF or revascularization) and other non-fatal vascular or bleeding outcomes in patients admitted with CCF. Methods Hospitalised patients in New South Wales (NSW), the largest state of Australia, from 1 July 2003 to 31 March 2021 with a primary diagnosis of CCF were identified from the statewide Admitted-Patient-Data-Collection database, stratified by AF (Prior-AF or New-AF during index CCF admission) and No-AF status, with follow-up until 31 March 2022. A linkage look-back to year-2001 was performed to identify prior-AF history. In addition to MACE, non-fatal outcomes assessed included recurrent admission with AF, haemorrhagic stroke, peripheral arterial thromboembolism, pulmonary embolism, and bleeding. Multivariable Cox regression was performed to assess the impact of AF on MACE. To account for the competing risk of death and assess the impact of AF on non-fatal cardiovascular outcomes, Fine-Gray competing risk analysis was performed. Results The cohort comprised 152 638 admitted CCF patients (median age: 80.4 years; 51.4% males): New-AF, n=16 371 (10.7%); Prior-AF, n=56 546 (37.0%) (Table 1). During a median follow-up of 2.5 years, compared to No-AF CCF patients, those with New-AF or Prior-AF had significantly higher rates of MACE (New-AF: 81.7% vs Prior-AF: 86.3% vs No-AF: 78.5%) driven by all-cause mortality (New-AF: 71.6% vs Prior-AF: 76.5% vs No-AF: 66.2%) (both logrank P<0.001). However, after adjusting for differences in baseline characteristics and admission year-groups, New-AF and Prior-AF status had differential impact on MACE compared to No-AF patients (adjusted hazard ratio [aHR]=0.93, 95% confidence interval [CI]=0.91-0.94; aHR=1.14, 95%CI=1.13-1.16 respectively; both P<0.001). Results were similar for all-cause death (aHR=0.94 and aHR=1.16 respectively; both P<0.001). Competing risk analyses showed that rehospitalisation for ischaemic stroke, AF, haemorrhagic stroke, peripheral arterial thromboembolism and bleeding were significantly higher in CCF patients with New-AF and Prior-AF (P<0.001), after adjusting for age, sex, referral source, year-groups, intensive-care-unit admission and Charlson comorbidities index (Table 2). Conclusion This study shows that AF status has a differential impact on clinical outcomes in patients admitted with CCF. Drivers behind this difference in outcomes require further study and strategies should be developed to minimise the risk of adverse clinical outcomes in this vulnerable group of patients.Table 1.Baseline characteristicsTable 2.Non-fatal CV outcomes

Systemic vascular resistance predicts high-output cardiac failure in patients with high-flow arteriovenous fistula.

Patients with high-flow arteriovenous (AV) access are at risk of developing high-output cardiac failure (HOCF) and subsequent hospitalization. However, diagnosing HOCF is challenging and often requires invasive procedures. The role of systemic vascular resistance (SVR) in diagnosing HOCF is underestimated, and its predictive value is limited. Our study aims to identify non-invasive risk factors for HOCF to facilitate early diagnosis and timely surgical interventions. We included 109 patients with high-flow AV access who underwent serial echocardiography. The retrospective cohort was divided into two groups based on their hospitalization due to HOCF. The two groups were matched for age and gender. After a mean follow-up of 25.1months, 19 patients (17.4%) were hospitalized due to HOCF. The two groups had similar baseline characteristics. However, the HOCF group had a higher value of vascular access blood flow (Qa) (2168±856 vs. 1828±617mL/min; P=0.045). Echocardiographic analysis revealed that the HOCF group had more pronounced left ventricular diastolic dysfunction (E/e': 21.1±7.3 vs. 16.2±5.9; P=0.002), more severe pulmonary hypertension (right ventricular systolic pressure: 41.4±16.7 vs. 32.2±12.8; P=0.009), a higher Doppler-derived cardiac index (CI) (4.3±0.8 vs. 3.7±1.1; P=0.031), and a lower Doppler-derived estimated SVR (eSVR) value (5.5±0.3 vs. 6.9±0.2; P=0.002) than the non-HOCF group. Using multivariable Cox regression analysis, a low eSVR value (<6) emerged as an independent predictor of HOCF hospitalization with a hazard ratio of 9.084 (95% confidence interval, 2.33-35.39; P=0.001). Receiver operating characteristic curve analysis indicated that CI/eSVR values more accurately predicted HOCF hospitalization [sensitivity: 94.7%, specificity: 51.0%, area under the curve (AUC): 0.75, P<0.001] than the Qa/cardiac output ratio (AUC: 0.50, P=0.955), Qa values≥2000mL/min (AUC: 0.60, P=0.181), and Qa values indexed for height in metres (AUC: 0.65, P=0.040). In patients with high-flow AV access, low eSVR values obtained through non-invasive Doppler echocardiography were associated with a high rate of HOCF hospitalizations. Therefore, routine eSVR screening in these patients might expedite the diagnosis of HOCF.

“Study of Psychosocial Antecedents to Precipitation of Congestive Heart Failure in Cardiac Patients: A Prospective Observational Study”

Introduction: Psychosocial factors, such as stress, adversity, socioeconomic status, depression, and anxiety, are associated with overall health and with cardiovascular health in particular. Psychosocial risk factors have been frequently studied in relation to coronary heart disease. In observational studies, high levels of depression and anxiety have consistently been associated with incident coronary heart disease, whereas associations with hostility and social support have been mixed. However, psychosocial factors have been examined less often in HF. Among patients with HF, depression is the most commonly researched psychosocial risk factor. Aim of the study: The aim of this study was to determine the psychosocial antecedents to precipitation of congestive heart failure in cardiac patients. Methods: This was a prospective study and was conducted in the Department of Cardiology of Lugansk State Medical University (LSMU), Hospital No-01, Lugansk, Ukraine during the period from November, 2008 to September 2009. We included 120 patients with heart disease in our study. The patients were randomly divided into two groups – HF group (Patients who hadn’t any heart failure, n=60) and No-HF group (Patients who had heart failure, n=60) Result: In total 120 patients from both the groups completed the study. In our study we found majority (35.83%) of our patients were aged 61-70 years and most of our patients were female (62%) compared to male (38%). We found the mean age was 49.73 ± 8.9 years. Among all patients 76.67% were smoker, 70% had DM, 80% had history of hypertension, 31.67% had asthma, 59.17% had previous history of CVD and the mean duration of CVD was 3.29±2.41 years. The mean BMI was 27.67±4.24 kg/m2. TC, HDL &amp; LDL was higher in no-HF group which indicates a lower risk of heart disease while Tg was higher in HF group indicating a great risk of heart disease. We also found CRP , albumin &amp; fibrinogen was higher in HF group that indicates a greater risk of heart disease. Among all psychosocial factors, anger, anxiety, depressive symptoms, hostility and self-reported health were found higher in HF group compared to no-HF group. Conclusion: In our study, we found statistically significant relationships between psychosocial factors and incident HF. However, adverse levels of psychosocial factors played a role to be an indicator of HF development among cardiac patients. We found psychosocial risk factors such as anger, anxiety, depressive symptoms, hostility and self-reported health as an indicator of congestive heart failure among our cardiac patients.

FACTORS PRECIPITATING HEART FAILURE IN PATIENTS WITH RHEUMATIC HEART DISEASE IN TERTIARY CARE TEACHING HOSPITAL.

Introduction: Streptococcus pyogenes group A beta-hemolytic produces rheumatic heart disease, a chronic condition. In countries with low and intermediate incomes, it signicantly increases morbidity and mortality. Aims and objectives: To assess the precipitating causes for Frank congestive cardiac failure in patients with established RHD and evaluate the diagnostic problems of fresh rheumatic activity versus infective endocarditis. This was a hospital-based prospective, observational study conducted on Methodology: 150 patients with RHD with cardiac failure admitted to the tertiary care centre in the hospital in the department of general medicine. In patients (≤20 years) Fresh Rheumatic Activity Results: (FRA) was the single most important factor in 85.7%, followed by infection (47.8%) while in patients &gt;20 years, infective endocarditis (92.9%), strenuous physical activity (84.2%) and irregular treatment (72.4%), were a few of the more common factors responsible for precipitation of CCF as compared with patients ≤20 years of age. FRA and infective endocarditis we Conclusion: re the most common precipitating factors in patients ≤20 years and &gt;20 years respectively

Gender Based Disparities Among Wide Range of Cardiac Failure Patients Reporting at Benazir Bhutto Hospital Rawalpindi During 2019-2020

Objectives: To determine gender-based variations among cardiac failure patients visiting a tertiary care hospital of Rawalpindi during 2019- 2020.

Colchicine Is a Weapon for Managing the Heart Disease Among Interstitial Lung Disease With Viral Infection: Have We Found the Holy Grail?

BackgroundThis study investigated the effect of colchicine use on the risks of heart disease (HD), pericarditis, endocarditis, myocarditis, cardiomyopathy, cardiac arrhythmia, and cardiac failure in patients having interstitial lung disease (ILD) with virus infection (ILD cohort).MethodsWe retrospectively enrolled ILD cohort between 2000 and 2013 from the Longitudinal Health Insurance Database and divided them into colchicine users (n = 12,253) and colchicine non-users (n = 12,253) through propensity score matching. The event of interest was the diagnosis of HD. The incidence of HD was analyzed using multivariate Cox proportional hazards models between colchicine users and the comparison cohort after adjustment for age, sex, medication, comorbidities, and index date based on the time-dependent analysis.ResultsColchicine users had a significantly lower risk of HD (aHR = 0.87, 95% confidence interval (CI]) = 0.82–0.92) than did the colchicine non-user. For colchicine non-users as the reference, the aHR (95% CI) of the patients who received colchicine of 2–7, 8–30, 31–150, and > 150 days were 0.89 (0.81–0.98), 0.84 (0.76–0.94), 090 (0.80–0.99), and 0.83 (0.74–0.93), respectively; regardless of duration use, the lower risk of HD persisted in colchicine users. The cumulative incidence of HD in colchicine users was significantly lower than that in the colchicine non-users (log-rank p < 0.001).ConclusionThe addition of short-term or long-term colchicine to standard medical therapy may have benefits to prevent the HD among the ILD patients concurrent with a virus infection or comorbidities even in elderly patients.

Prevalence of Cardiovascular Dysfunction and its Association with Outcomes in Patients with Acute Pancreatitis

Background and Aim: Acute pancreatitis is a rapid progressive abdominal inflammatory disease with acute onset in clinics which turns into severe acute pancreatitis. In approximately 20% of patients characterized by different parameters such as gland flaky necrosis, multiple organ dysfunction syndrome (MODS), inflammatory cell infiltration in large number, and hemorrhage. Electrocardiography and electromyography variations are the common cardiac failure in patients with acute pancreatitis. Elevated cardiac enzymes could be other factors for cardiac failure with acute pancreatitis. The present study aimed to assess the prevalence of cardiovascular dysfunction and its association in patients with acute pancreatitis. Methodology: This cross-sectional study was carried out on 120 acute appendicitis patients in the department of Gastroenterology at Northwest General Hospital &amp; Research Centre, Hayatabad Peshawar for the duration of six months from June 2021 to November 2021. All the patients who met the inclusion criteria were enrolled. Echocardiography and CK-MB (creatine phosphokinase isoenzyme) was measured for evaluating myocardial function after admission. All the patients underwent physical, clinical, and laboratory examination. The findings of Electrocardiography (ECG) were recorded. Acute appendicitis severity, duration of hospital stay, infection, computed tomography severity index (CTSI), and mortality were different outcomes. Results: Of the total 120 patients, about 83 (69.2%) were males and 37 (30.8%) were females. The overall mean age was 37.84±12.46 years. Out of 120 acute pancreatitis patients, the prevalence of gallstone disease, organic failure, respiratory failure, acute kidney failure, and cardiovascular dysfunction was 51 (43.3%), 47 (39.2%), 37 (30.8%), 19 (15.8%), and 9 (7.5%) respectively. Elevated CK-MB and ECG changes were seen in 32 (26.7%) and 42 (35%) respectively. The ECG variations and elevated CK-MB were related with severity of acute pancreatitis (p&lt;0.05), duration of hospital (OR: 18.9 ± 10.6 vs. 11.7 ± 6.8, p = 0.005), CTSI (6.9 ± 3.1 vs. 4.7 ± 2.9, p = 0.001), increased necrosis (2.34, 95%CI= 0.3-11.8, p=0.011), and mortality (OR= 5.46, 95% CI= 1.2-34.9, p=0.05). The incidence of Left ventricular systolic dysfunction (LVEF) and left ventricular diastolic dysfunction (LVDD) was 15 (12.5%) and 31 (25.8%) respectively. Conclusion: The present study found that elevated CK-MB were significantly associated with higher CTSI, Prolonged hospital stay, severity of acute pancreatitis, LVDD, increased necrosis, and mortality. CK-MB increased levels have been reported as an indicator for cardiac failure and acute pancreatitis. There was a significant association between increased CK-MB levels and cardiovascular organ failure, pancreatic necrosis, and left ventricular diastolic dysfunction. Keywords: Cardiovascular dysfunction, Acute pancreatitis, Outcomes

Effect of exercise program on health-related Quality of Life (QOL) in Congestive Cardiac Failure patients

Heart Failure is a common cardiovascular condition with increasing incidence and prevalence. Congestive cardiac failure continues to be a major cause of death throughout the world despite dramatic advances made in the treatment over the last 25 years. As it is growing and people are affected by it, the nurse has an important role in helping the people to live with the disease and control it through various preventive and therapeutic measures. Exercise and education programs are designed to improve the patient’s quality of life after a heart failure or another heart problem. It includes a program of structured exercise that is now generally believed not only to improve morbidity but also to reduce mortality in patients who have suffered a CCF. Material and Method: A Quasi-experimental post-study only design without a control group approach was undertaken in Pravara Rural Hospital. A total of 30 congestive cardiac failure patients were randomly assigned to receive the intervention of the Exercise program. The nurse investigator provided 05 minutes exercise program. Assessment of effectiveness is performed by evaluating Quality of Life. The data were analyzed with descriptive and inferential statistics, wherever required. Results: It was found that the exercise program significantly improved QOL. A statistically significant difference was found between the group QOL (t=15.47) there was a significant association found between socio-demographic characteristics (0 . 840 dna 8.8.0 ) at p&lt;0.05 level. Conclusion: The study outcome revealed that the exercise program was found to be effective in improving the QOL among congestive cardiac failure patients. Hence it should be emphasized that exercise programs should be practiced for the vulnerable CCF patient with routine care.

Effect of exercise program on health-related Quality of Life (QOL) in Congestive Cardiac Failure patients

Background:Heart Failure is a common cardiovascular condition with increasing incidence and prevalence. Congestive cardiac failure continues to be a major cause of death throughout the world despite dramatic advances made in the treatment over the last 25 years. As it is growing and people are affected by it, the nurse has an important role in helping the people to live with the disease and control it through various preventive and therapeutic measures. Exercise and education programs are designed to improve the patient’s quality of life after a heart failure or another heart problem. It includes a program of structured exercise that is now generally believed not only to improve morbidity but also to reduce mortality in patients who have suffered a CCF. Material and Method: A Quasi-experimental post-study only design without a control group approach was undertaken in Pravara Rural Hospital. A total of 30 congestive cardiac failure patients were randomly assigned to receive the intervention of the Exercise program. The nurse investigator provided 05 minutes exercise program. Assessment of effectiveness is performed by evaluating Quality of Life. The data were analyzed with descriptive and inferential statistics, wherever required. Results: It was found that the exercise program significantly improved QOL. A statistically significant difference was found between the group QOL (t=15.47) there was a significant association found between socio-demographic characteristics (0 . 840 dna 8.8.0 ) at p&lt;0.05 level. Conclusion: The study outcome revealed that the exercise program was found to be effective in improving the QOL among congestive cardiac failure patients. Hence it shouldbe emphasized that exercise programs should be practiced for the vulnerable CCF patient with routine care.

Echocardiography for extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary life support for patients in cardiac and/or respiratory failure. Echocardiography provides essential diagnostic and anatomic information prior to ECMO initiation, allows for safe and efficient ECMO cannula positioning, guides optimization of flow, provides a modality for rapid troubleshooting and patient evaluation, and facilitates decision-making for eventual weaning of ECMO support. Currently, guidelines for echocardiographic assessment in this clinical context are lacking. In this review, we provide an overview of echocardiographic considerations for advanced imagers involved in the care of these complex patients. We focus predominately on new cannulas and complex cannulation techniques, including a special focus on double lumen cannulas and a section discussing indirect left ventricular venting. Echocardiography is tremendously valuable in providing optimal care in these challenging clinical situations. It is imperative for imaging physicians to understand the pertinent anatomic considerations, the often complicated physiological and hemodynamic context, and the limitations of the imaging modality.

Neurologic Complications of Extracorporeal Cardiopulmonary Resuscitation in Neonates and Infants

Objective: Extracorporeal membrane oxygenation (ECMO) is a lifesaving measure for patients in cardiac or respiratory failure. Extracorporeal cardiopulmonary resuscitation (ECPR) is emergent ECMO cannulation during cardiac arrest. All ECMO patients are at high risk for neurologic complications, but the degree of risk of ECPR relative to ECMO without CPR in progress (non-ECPR ECMO) is not well documented in infants. The goal of the present study is to compare neurologic complication rates between infants who underwent ECPR and those who underwent non-ECPR ECMO. Methods: We performed a retrospective chart review on all patients admitted between 2009 and 2020 to the neonatal intensive care unit (NICU) in our quaternary children's hospital. We separated patients by ECPR vs. non-ECPR ECMO cannulation. We compared rates of death and used neuroimaging and video electroencephalogram (vEEG) to determine incidence of stroke, intracranial hemorrhage, and seizure. Chi-square and Fisher's exact tests were used to compare these categorical variables among groups.Results: A total of 181 infants were cannulated onto ECMO. Of these, 40 received ECPR, 56 received non-ECPR ECMO for a cardiac indication, and 85 received non-ECPR ECMO for a respiratory indication. After excluding patients currently admitted (n=1, ECPR), 180 patients were subjected to analysis. ECPR patients were less likely to survive to hospital discharge than patients who underwent non-ECPR ECMO for respiratory indications, and less likely to survive without any neurologic complication compared with infants who underwent non-ECPR ECMO for cardiac or respiratory indications. Interpretation: Significantly fewer ECPR patients survived without experiencing a neurologic complication, compared with non-ECPR ECMO patients.

Prevalence of deep vein thrombosis in congestive cardiac failure patients

BACKGROUND: Congestive cardiac failure (CCF) and deep vein thrombosis (DVT) may coexist in a patient. The prevalence of DVT has been reported up to 34.1% in CCF patients, and its presence may increase the morbidity and mortality of CCF patients. The presence of DVT may increase the morbidity and mortality of CCF patients. With this background in mind, we conducted a study to know the prevalence of DVT in CCF patients from our part of the world.MATERIALS AND METHODS: An analytical cross-sectional study was carried out over a period of 1 year from March 2015 to February 2016 on 50 patients admitted with CCF to our hospital. After obtaining information on underlying comorbid illness, duration of CCF symptoms, and preliminary investigations, the patients were subjected to venous Doppler ultrasound.RESULTS: A total of 50 patients admitted with the diagnosis of CCF were enrolled in this study. The mean age of patients was 63.28 ± 9.5 years. The mean body mass index of the patients was 24.48 ± 2.8 kg/m2. Five out of 50 patients were found to have deep vein thrombosis in our study. The duration of symptoms of more than 10 days before seeking medical consultation was statistically significant in patients of CCF with DVT.CONCLUSION: In our study, 10% of patients with CCF had DVT on venous Doppler ultrasound. A longer duration of CCF symptoms before seeking medical consultation was significantly associated with DVT in our patients.

Membrane Oxygenator for Extracorporeal Blood Oxygenation

Extracorporeal blood oxygenation has become an alternative to supply O2 and remove CO2 from the bloodstream, especially when mechanical ventilation provides insufficient oxygenation. The use of a membrane oxygenator offers the advantage of lower airway pressure than a mechanical ventilator to deliver oxygen to the patient’s blood. However, research and development are still needed to find appropriate membrane materials, module configuration, and to optimize hydrodynamic conditions for achieving high efficient gas transfer and excellent biocompatibility of the membrane oxygenator. This review aims to provide a comprehensive description of the basic principle of the membrane oxygenator and its development. It also discusses the role and challenges in the use of membrane oxygenators for extracorporeal oxygenation on respiratory and cardiac failure patients.