Cardiovascular Intensive Care Unit Research Articles

Determinants of 30-day mortality in elderly patients admitted to a cardiovascular surgery intensive care unit.

This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery. Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed. Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05). By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.

A parental communication assessment initiative in the paediatric cardiovascular ICU.

Challenges to communication between families and care providers of paediatric patients in intensive care units (ICU) include variability of communication preferences, mismatched goals of care, and difficulties carrying forward family preferences from provider to provider. Our objectives were to develop and test an assessment tool that queries parents of children requiring cardiac intensive care about their communication preferences and to determine if this tool facilitates patient-centred care and improves families' ICU experience. In this quality improvement initiative, a novel tool was developed, the Parental Communication Assessment (PCA), which asked parents with children hospitalised in the cardiac ICU about their communication preferences. Participants were prospectively randomised to the intervention group, which received the PCA, or to standard care. All participants completed a follow-up survey evaluating satisfaction with communication. One hundred thirteen participants enrolled and 56 were randomised to the intervention group. Participants who received the PCA preferred detail-oriented communication over big picture. Most parents understood the daily discussions on rounds (64%) and felt comfortable expressing concerns (68%). Eighty-six percent reported the PCA was worthwhile. Parents were generally satisfied with communication. However, an important proportion felt unprepared for difficult decisions or setbacks, inadequately included or supported in decision-making, and that they lacked control over their child's care. There were no significant differences between the intervention and control groups in their communication satisfaction results. Parents with children hospitalised in the paediatric ICU demonstrated diverse communication preferences. Most participants felt overall satisfied with communication, but individualising communication with patients' families according to their preferences may improve their experience.

Rapid Whole-Genome Sequencing and Clinical Management in the PICU: A Multicenter Cohort, 2016-2023.

Analysis of the clinical utility of rapid whole-genome sequencing (rWGS) outside of the neonatal period is lacking. We describe the use of rWGS in PICU and cardiovascular ICU (CICU) patients across four institutions. Ambidirectional multisite cohort study. Four tertiary children's hospitals. Children 0-18 years old in the PICU or CICU who underwent rWGS analysis, from May 2016 to June 2023. None. A total of 133 patients underwent clinical, phenotype-driven rWGS analysis, 36 prospectively. A molecular diagnosis was identified in 79 patients (59%). Median (interquartile range [IQR]) age was 6 months (IQR 1.2 mo-4.6 yr). Median time for return of preliminary results was 3 days (IQR 2-4). In 79 patients with a molecular diagnosis, there was a change in ICU management in 19 patients (24%); and some change in clinical management in 63 patients (80%). Nondiagnosis changed management in 5 of 54 patients (9%). The clinical specialty ordering rWGS did not affect diagnostic rate. Factors associated with greater odds ratio (OR [95% CI]; OR [95% CI]) of diagnosis included dysmorphic features (OR 10.9 [95% CI, 1.8-105]) and congenital heart disease (OR 4.2 [95% CI, 1.3-16.8]). Variables associated with greater odds of changes in management included obtaining a genetic diagnosis (OR 16.6 [95% CI, 5.5-62]) and a shorter time to genetic result (OR 0.8 [95% CI, 0.76-0.9]). Surveys of pediatric intensivists indicated that rWGS-enhanced clinical prognostication (p < 0.0001) and contributed to a decision to consult palliative care (p < 0.02). In this 2016-2023 multiple-PICU/CICU cohort, we have shown that timely genetic diagnosis is feasible across institutions. Application of rWGS had a 59% (95% CI, 51-67%) rate of diagnostic yield and was associated with changes in critical care management and long-term patient management.

Anaerobic Lactate Production Is Associated With Decreased Microcirculatory Blood Flow and Decreased Mitochondrial Respiration Following Cardiovascular Surgery With Cardiopulmonary Bypass.

Quantify the relationship between perioperative anaerobic lactate production, microcirculatory blood flow, and mitochondrial respiration in patients after cardiovascular surgery with cardiopulmonary bypass. Serial measurements of lactate-pyruvate ratio (LPR), microcirculatory blood flow, plasma tricarboxylic acid cycle cycle intermediates, and mitochondrial respiration were compared between patients with a normal peak lactate (≤ 2 mmol/L) and a high peak lactate (≥ 4 mmol/L) in the first 6 hours after surgery. Regression analysis was performed to quantify the relationship between clinically relevant hemodynamic variables, lactate, LPR, and microcirculatory blood flow. This was a single-center, prospective observational study conducted in an academic cardiovascular ICU. One hundred thirty-two patients undergoing elective cardiovascular surgery with cardiopulmonary bypass. None. Patients with a high postoperative lactate were found to have a higher LPR compared with patients with a normal postoperative lactate (14.4 ± 2.5 vs. 11.7 ± 3.4; p = 0.005). Linear regression analysis found a significant, negative relationship between LPR and microcirculatory flow index (r = -0.225; β = -0.037; p = 0.001 and proportion of perfused vessels: r = -0.17; β = -0.468; p = 0.009). There was not a significant relationship between absolute plasma lactate and microcirculation variables. Last, mitochondrial complex I and complex II oxidative phosphorylation were reduced in patients with high postoperative lactate levels compared with patients with normal lactate (22.6 ± 6.2 vs. 14.5 ± 7.4 pmol O2/s/106 cells; p = 0.002). Increased anaerobic lactate production, estimated by LPR, has a negative relationship with microcirculatory blood flow after cardiovascular surgery. This relationship does not persist when measuring lactate alone. In addition, decreased mitochondrial respiration is associated with increased lactate after cardiovascular surgery. These findings suggest that high lactate levels after cardiovascular surgery, even in the setting of normal hemodynamics, are not simply a type B phenomenon as previously suggested.

Feasibility and Performance of Continuous Glucose Monitoring to Guide Computerized Insulin Infusion Therapy in Cardiovascular Intensive Care Unit.

We evaluated the feasibility of real-time continuous glucose monitoring (CGM) for titrating continuous intravenous insulin infusion (CII) to manage hyperglycemia in postoperative individuals in the cardiovascular intensive care unit and assessed their accuracy, nursing acceptance, and postoperative individual satisfaction. Dexcom G6 CGM devices were applied to 59 postsurgical patients with hyperglycemia receiving CII. A hybrid approach combining CGM with periodic point-of-care blood glucose (POC-BG) tests with two phases (initial-ongoing) of validation was used to determine CGM accuracy. Mean and median absolute relative differences and Clarke Error Grid were plotted to evaluate the CGM accuracy. Surveys of nurses and patients on the use of CGMs experience were conducted and results were analyzed. In this cohort (mean age 64, 32% female, 32% with diabetes) with 864 paired POC-BG and CGM values analyzed, mean and median absolute relative difference between POC-BG and CGM values were 13.2% and 9.8%, respectively. 99.7% of paired CGM and POC-BG were in Zones A and B of the Clarke Error Grid. Responses from nurses reported CGMs being very or quite convenient (n = 28; 93%) and it was favored over POC-BG testing (n = 28; 93%). Majority of patients (n = 42; 93%) reported their care process using CGM as being good or very good. This pilot study demonstrates the feasibility, accuracy, and nursing convenience of adopting CGM via a hybrid approach for insulin titration in postoperative settings. These findings provide robust rationale for larger confirmatory studies to evaluate the benefit of CGM in postoperative care to improve workflow, enhance health outcomes, and cost-effectiveness.

Critical Care Alarm Fatigue and Monitor Customization: Alarm Frequencies and Context Factors.

Alarm fatigue among nurses working in the intensive care unit has garnered considerable attention as a national patient safety priority. A viable solution for reducing the frequency of alarms and unnecessary noise is intensive care unit alarm monitor customization. A 24-bed cardiovascular and thoracic surgery intensive care unit in a large academic medical center identified a high rate of alarms and associated noise as a problem contributing to nurse alarm fatigue. An alarm monitor quality improvement project used both alarm frequency and nurse surveys before and after implementation to determine the effectiveness of interventions. Multimodal interventions included nurse training sessions, informational flyers, organizational policies, and an alarm monitor training video. Unexpected results inspired an extensive investigation and secondary analysis, which included examining the data-capturing capabilities of the alarm monitors and the impact of context factors. Alarm frequencies unexpectedly increased after the intervention. The software data-capturing features of the alarm monitors for determining frequency did not accurately measure nurse interactions with monitors. Measured increases in patient census, nurse staffing, and data input from medical devices from before to after the intervention substantially affected project results. Alarm frequencies proved an unreliable measure of nurse skills and practices in alarm customization. Documented changes in context factors provided strong anecdotal evidence of changed circumstances that clarified project results and underscored the critical importance of contemporaneous collection of context data. Designs and methods used in quality improvement projects must include reliable outcome measures to achieve meaningful results.

Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study

BackgroundPaxlovid has been shown to be effective in reducing mortality and hospitalization rates in patients with coronavirus disease 2019 (COVID-19). It is not known whether Paxlovid can reduce the risk of cardiovascular diseases (CVD) in COVID-19-surviving patients with autoimmune rheumatic diseases (AIRDs).MethodsTriNetX data from the US Collaborative Network were used in this study. A total of 5,671,395 patients with AIRDs were enrolled between January 1, 2010, and December 31, 2021. People diagnosed with COVID-19 were included in the cohort (n = 238,142) from January 1, 2022, to December 31, 2022. The Study population was divided into two groups based on Paxlovid use. Propensity score matching was used to generate groups with matched baseline characteristics. The hazard ratios (HRs) and 95% confidence intervals of cardiovascular outcomes, admission rate, mortality rate, and intensive care unit (ICU) admission rate were calculated between Paxlovid and non-Paxlovid groups. Subgroup analyses on sex, age, race, autoimmune diseases group, and sensitivity analyses for Paxlovid use within the first day or within 2–5 days of COVID-19 diagnosis were performed.ResultsPaxlovid use was associated with lower risks of cerebrovascular complications (HR = 0.65 [0.47–0.88]), arrhythmia outcomes (HR = 0.81 [0.68–0.94]), ischemic heart disease, other cardiac disorders (HR = 0.51 [0.35–0.74]) naming heart failure (HR = 0.41 [0.26–0.63]) and deep vein thrombosis (HR = 0.46 [0.24–0.87]) belonging to thrombotic disorders in AIRD patients with COVID-19. Compared with the Non-Paxlovid group, risks of major adverse cardiac events (HR = 0.56 [0.44–0.70]) and any cardiovascular outcome mentioned above (HR = 0.76 [0.66–0.86]) were lower in the Paxlovid group. Moreover, the mortality (HR = 0.21 [0.11–0.40]), admission (HR = 0.68 [0.60–0.76]), and ICU admission rates (HR = 0.52 [0.33–0.80]) were significantly lower in the Paxlovid group than in the non-Paxlovid group. Paxlovid appears to be more effective in male, older, and Black patients with AIRD. The risks of cardiovascular outcomes and severe conditions were reduced significantly with Paxlovid prescribed within the first day of COVID-19 diagnosis.ConclusionsPaxlovid use is associated with a lower risk of CVDs and severe conditions in COVID-19-surviving patients with AIRD.

Comparison of Outcomes in Patients Requiring Mechanical Circulatory Support Who Received Cangrelor in Addition to Anticoagulation Versus Anticoagulation Alone

ObjectivesTo evaluate the safety of cangrelor administered concurrently with heparin or bivalirudin in patients on mechanical circulatory support. DesignA single-center, retrospective, cohort study of adult patient consecutively admitted between January 2016 and October 2020 SettingA tertiary medical center. ParticipantsAdult patients admitted to the cardiovascular intensive care unit initiated on mechanical circulatory support for acute myocardial infarction (AMI) or non-AMI indications. Patients who received cangrelor underwent percutaneous coronary intervention with stenting during the index event or within the last year. InterventionsNone. Measurements and Main ResultsThe primary outcome was the incidence of major bleeding, defined by the Extracorporeal Life Support Organization criteria, in patients with mechanical circulatory support receiving cangrelor plus anticoagulation with heparin or bivalirudin with or without aspirin versus patients who did not receiving cangrelor. Sixty-eight patients were included in the study. Twenty-nine patients received cangrelor and 39 did not. Cangrelor was not associated with an increase in major bleeding, however our confidence interval was wide (adjusted hazard ratio [aHR] 1.93, 95% CI 0.61-6.11; p=0.262). ConclusionsPatients receiving cangrelor did not appear to be at higher risk of major bleeding compared to patients not receiving cangrelor. Larger trials should be conducted to better evaluate the safety of cangrelor in patients on mechanical circulatory support.

The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions.

(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel-Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59-80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6-3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.

Right ventricular infarction: epidemiological, clinical, and angiographic characteristics and the outcomes through the experience of a Moroccan cardiology department

Background: Acute myocardial infarction (MI) is a major cause of cardiovascular mortality, which is the leading cause of death in the world. Our objective in this study was to evaluate the epidemiological, clinical, and angiographic features of right ventricular infarction (RVI), as well as its complications and its therapeutic approaches. Patients and methods: It is a single-centered retrospective descriptive study conducted over a period of 2 years from November 2018 to October 2020. The authors included 82 patients with RVI hospitalized in the cardiovascular ICU during the initial phase of acute coronary syndrome with persistent ST segment elevation. Patients who were diagnosed with RVI at electrocardiogram and echocardiography were recruited. Results: The authors included 500 patients hospitalized for STEMI, 82 had MI extended to the RV, reflecting a rate of 16.4%. The mean age in our study was 64±12.3 years. Dyslipidemia, diabetes mellitus, and hypertension were the most common cardiovascular risk factors among these patients. RVI co-existed with inferior MI in 62.2 of cases and in 37.8% of anterior MI, while isolated RVI was seen in only one patient. Transthoracic echocardiography showed right ventricular (RV) systolic dysfunction in 24.39% of cases, while RV dilatation was seen in only 10.9% of patients. Therapeutic approach was based essentially on revascularization with thrombolysis and coronary angiography +/- PCI. The percentage of mortality was 2.4%. Conclusion: RVI is relatively rare and is mostly related to an extension of an inferior MI. Early diagnosis, prompt treatment, and appropriate are the keys to improve prognosis, and reduce complications.

Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry.

Wide interhospital variations exist in cardiovascular intensive care unit (CICU) admission practices and the use of critical care restricted therapies (CCRx), but little is known about the differences in patient acuity, CCRx utilization, and the associated outcomes within tertiary centers. The Critical Care Cardiology Trials Network is a multicenter registry of tertiary and academic CICUs in the United States and Canada that captured consecutive admissions in 2-month periods between 2017 and 2022. This analysis included 17 843 admissions across 34 sites and compared interhospital tertiles of CCRx (eg, mechanical ventilation, mechanical circulatory support, continuous renal replacement therapy) utilization and its adjusted association with in-hospital survival using logistic regression. The Pratt index was used to quantify patient-related and institutional factors associated with CCRx variability. The median age of the study population was 66 (56-77) years and 37% were female. CCRx was provided to 62.2% (interhospital range of 21.3%-87.1%) of CICU patients. Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST-elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. The unadjusted in-hospital mortality (median, 12.7%) was 9.6%, 11.1%, and 18.7% in low, intermediate, and high CCRx tertiles, respectively. No clinically meaningful differences in adjusted mortality were observed across tertiles when admissions were stratified by the provision of CCRx. Baseline patient-level variables and institutional differences accounted for 80% and 5.3% of the observed CCRx variability, respectively. In a large registry of tertiary and academic CICUs, there was a >4-fold interhospital variation in the provision of CCRx that was primarily driven by differences in patient acuity compared with institutional differences. No differences were observed in adjusted mortality between low, intermediate, and high CCRx utilization sites.

Usefulness of the quick-SOFA Score in Cardiovascular intensive care unit to Predict prognosis in Acute Coronary Syndrome

Usefulness of the quick-SOFA Score in Cardiovascular intensive care unit to Predict prognosis in Acute Coronary Syndrome

Usefulness of the quick-SOFA Score in Cardiovascular intensive care unit to Predict prognosis in Acute Coronary Syndrome

Usefulness of the quick-SOFA Score in Cardiovascular intensive care unit to Predict prognosis in Acute Coronary Syndrome

2481. Interactive Dashboards for Improved Tracking and Communication of CLABSI Prevention Efforts

Abstract Background Central line-associated bloodstream infections (CLABSI) are associated with increased morbidity, mortality, and healthcare costs. Many CLABSIs can be prevented using evidence-based care. To make this information more accessible and actionable, we developed interactive dashboards that translate data on CLABSI-related metrics and prevention efforts into visual formats that can be easily understood by healthcare professionals. Methods A multidisciplinary work group of data analysts, infectious diseases physicians, and infection preventionists determined the content and layout of the dashboards. A query was written to extract necessary data elements from the Electronic Medical Record and NHSN. Data was then exported and used to build the dashboards using Tableau® software. The dashboard can be filtered at the facility level or at the unit level. Results We present the dashboard of one general ward (Figure 1), one intensive care unit (ICU) (Figure 2), and one cardiovascular ICU (CVICU) (Figure 3). The central line standard utilization ratio (SUR) was higher for the CVICU ( &amp;gt;1.5), followed by the ICU (≈1), and the general ward (&amp;lt; 1). Blood culture intensity (number of blood cultures collected/patient-days) was less for the general ward (&amp;lt; 5%), variable for the ICU (8-14%), and persistently higher for the CVICU (11%). Compliance with daily chlorhexidine bathing was higher for both the CVICU (80%) and the ICU (75%) compared to the general ward (40-60%). The CLABSI rate per 1,000 central line-days has been downtrending for the CVICU and uptrending for the ICU. Besides lower compliance with daily chlorhexidine bathing, the examined ICU has also recently shown a higher proportion of long-term devices (40%), calculated as proportion of central lines ≥ 7 days/all central lines, compared to the CVICU (25%). Conclusion Dashboards should contain meaningful outcomes and standardized process metrics that are mapped to strategic goals and be timely to support prompt identification of deviations. Our CLABSI dashboards are effective tools for communicating and tracking performance data. Filtering at the unit level allows us to identify unique unit characteristics, or “fingerprints,” and recognize specific areas for improvement. This enables us to develop targeted interventions for each unit. Disclosures All Authors: No reported disclosures

Cost-Effectiveness of Early Goal-Directed Therapy Using the FloTrac/EV1000 Platform in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Retrospective Analysis

Background: Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is a high-risk surgery with significant morbidity resulting in a prolonged stay in the intensive care unit (ICU) at an increased cost. Early goal-directed therapy (EGDT) using the FloTrac/EV1000 platform improved outcomes in these patients with shorter ICU stay but with extra cost for a FloTrac transducer. Objective: To assess the cost-effectiveness of implementing the FloTrac/EV1000 in these patients. Materials and Methods: The present study was a retrospective study. Sixty adult patients who underwent CABG with CPB were included and divided into two groups: the EV1000 and the Control group. The EV1000 group was managed with EGDT protocol using FloTrac/EV1000 platform. The Control group was managed using a standard protocol. The ICU and hospital stay of both groups were compared. Then, the authors assessed the daily ICU cost by including another 62 patients admitted to the cardiovascular and thoracic (CVT) ICU. Finally, the extra cost of a FloTrac transducer was compared with the saved CVT ICU cost. Results: The EV1000 group had a shorter CVT ICU stay, with mean difference of –23.7 h (95% CI –34.5 to –12.9, p&lt;0.001). The EV1000 group had a shorter ventilator time, as well as a shorter hospital stay. The average daily CVT ICU cost was 10,020.05 Baht. The extra cost of a FloTrac sensor was 5,000 Baht. The saved cost of CVT ICU exceeds the cost of a FloTrac by 5,020.05 Baht. Conclusion: The implementation of EGDT using the FloTrac/EV1000 platform in patients undergoing CABG with CPB improved patients’ outcomes resulting in less CVT ICU cost and better resource management of CVT ICU beds. The extra cost of the FloTrac sensor was offset by the larger amount of CVT ICU cost that was saved. Keywords: Cost-effectiveness; Early goal-directed therapy; FloTrac; Intensive care unit; ICU stay

Association of clinical outcomes and the use of telemetry monitors in patients with advanced heart failure

Abstract Background Telemetry is a remote technology transmitted by radio frequency that sends patients' electrocardiographic signals in real-time, through a Bluetooth wireless network to a monitor located in a cardiovascular intensive care unit (ICU). This device is indicated for patients admitted in hospital clinical units that need monitoring (24 hours) for previous history or risk of developing cardiac arrhythmias. Patients with advanced heart failure often receive inotropic/antiarrhythmic drugs in the cardiovascular ICU. When clinically stable, this type of patient can be discharged from the cardiovascular ICU and monitored remotely in hospital clinical units using telemetry. Purpose We aimed o evaluate the clinical profile of patients with telemetry and to associate those with advanced heart failure who receive inotropic/antiarrhythmic drugs with unfavorable composite outcomes (death or cardiac arrhythmia). Methods Retrospective cohort study. Telemetry records were collected by nurses from the cardiovascular intensive care unit of a public university hospital. The study period was from January 2020 to May 2022. All the procedures in this study were in accordance with the Helsinki Declaration and approved by the Institutional Ethics Committee. Results In a sample of 703 patients, the mean (±SD) age was 63.4 ± 14.4 years, predominantly male 452 (64.3%). The median stay of the monitored patients was 4 (2-7) days. Among the monitored patients, regarding telemetry indications, patients diagnosed with advanced heart failure who receive inotropic/antiarrhythmic drugs had a prevalence rate of 12.8%. Of these, 32 (35.6%) had at least 1 complication, identified by telemetry, related significantly to unfavorable composite outcomes (P&amp;lt;0.001). All these patients who had the event identification through telemetry received immediate assistance by the cardiovascular intensive care team. Conclusion The use of telemetry in patients with advanced heart failure who receive inotropic/antiarrhythmic drugs admitted to hospital clinical units was associated significantly with unfavorable composite outcomes. The early detection of clinical outcomes might be useful in decision-making and in reducing major complications.

Agreement of continuous non-invasive arterial blood pressure monitoring (CNAP) and pulmonary artery catheter thermodilution method in estimating the hemodynamic parameters of post CABG patients

Abstract Background The use of hemodynamic parameters in monitoring patients after coronary artery bypass surgery is an essential element of clinical practice. It helps intensivist and physicians to properly manage patients after surgery where hemodynamic parameters are usually dynamic and complicated. Pulmonary artery guided thermodilution (PACT) has been the gold standard in assessing the adequacy of cardiac output, however, its invasive nature is also associated with more complex procedures and the risk of complications, including infections. With the emergence of new non-invasive hemodynamic monitoring devices such as the CNAP (continuous non-invasive arterial pressure), alternative methods for hemodynamic monitoring is now possible. Compared to invasive methods, it is easier to use with an error-free application, safer, less risk of infection and more cost effective. Purpose To determine the agreement of Continuous non-invasive arterial pressure (CNAP) and pulmonary artery guided thermodilution in monitoring the hemodynamic parameters of patients who underwent coronary artery bypass graft surgery. Methods This is a cross-sectional study conducted at the cardiovascular surgical intensive care unit and included 63 patients with Coronary artery disease who underwent elective coronary artery bypass graft surgery. Cardiac output, Cardiac Index, Stroke volume and Systemic vascular resistance were simultaneously obtained using both the CNAP and PACT. Three consecutive sets of measurements were recorded for each patient with a 3 hour interval; during arrival at the ICU, 3 hours post op, and 6 hours post op. Results The mean difference between PACT-CO and CNAP-CO was -0.81 L/min (SD -1.18 to -0.44) with a 95% limits of agreement of -3.74 to 2.11 L/min on the 0 hour, -0.81L/min (SD -1.22 to -0.41) with a 95% limits of agreement of -1.98 to 1.18 L/min on the 3rd hour, and -0.77L/min (SD -1.08 to -0.46) with a 95% limits of agreement of -3.22 to 1.68 L/min on the 6th hour post op. The results showed a significant difference between the PACT and CNAP. However, a positive correlation was noted between PACT-CO and CNAP-CO, the correlation coefficient on the 0, 3rd and 6th hour were 0.5384, 0.5158, and 0.6265 respectively. Conclusion CNAP derived hemodynamic parameters had a high mean difference compared to the PACT and there was no agreement between the two methods. However, it was able to have a positive correlation with the PACT, making it possible for the CNAP to track the hemodynamic changes during the post operative course.

Pedunculated left endoventricular thrombosis complicated by cerebral stroke in patient with suspected peripartum cardiomyopathy: A case report

Peripartum cardiomyopathy (PPMC) is an infrequent form of cardiomyopathy, whose main presentation is characterized by systolic dysfunction that commonly emerges in the early postpartum period. Acute heart failure symptoms such as congestion and dyspnea are common manifestations of PPMC. Here, we present a case of a 32-year-old female who, after hospitalization, manifested dyspnea and thoracic pain linked to the findings a left endoventricular thrombus. After the admission to the intensive cardiovascular care unit, heart failure and anticoagulant therapies as well as non-steroidal anti-inflammatory drugs were administered, leading to initial improvement of the left ventricular global function. Five days after the treatment, the patient experienced aphasia and right hemiplegia. The cerebral angiography documented an M1 segment occlusion. After treating the occlusion with stent retriever thrombectomy, the symptoms regressed and she attained full recovery. Therefore, surgical thrombectomy should be prioritized as the treatment approach to removing the pedunculated left ventricular thrombus, considering the apical morphology of the pedunculated left ventricular thrombus and if the anticoagulant therapy gives rise to side effects.

Prognostic Value of Right Ventricular Longitudinal Shortening Fraction in Patients With ST-Elevation Myocardial Infarction: A Prospective Echocardiography Study

Background: Right ventricular systolic dysfunction (RVsD) frequently occurs in patients with ST-elevation myocardial infarction (STEMI). However, the diagnosis depends on the echocardiographic parameters to define RVsD. Right ventricle longitudinal shortening fraction (RV-LSF) is an accurate and reproducible two-dimensional speckle tracking parameter associated with clinical events in various pathologies.Objective: The aim of the study is to evaluate the association between RVsD and major adverse cardiovascular events (MACE) occurrence in a cohort of STEMI patients.Methods: Adult STEMI patients admitted to Amiens University Hospital's cardiovascular intensive care unit between May 2021 and November 2022, who underwent coronary angiography and TTE within 48 hours of admission, were included. RVsD was defined as RV-LSF < 20%. The primary outcome was MACE occurrence, including heart failure, myocardial infarction, stroke, and death within six months of admission. Multivariable Cox regression analysis with proportional hazard ratio (HR) models assessed the association between RVsD and MACE.Results: Among the 164 included patients, 72 (44%) had RVsD, and 92 (56%) did not. The RVsD group had a significantly higher proportion of MACE during the six-month follow-up (n = 23/72, 33%) than the no-RVsD group (n = 8/92, 9%; P = 0.001). RVsD showed an independent association with MACE at six months (HR=3.1, 95% CI [1.35-7.30], P=0.008). Left ventricular ejection fraction < 40 % and TIMI score > 4 were independently associated with RVsD (odds ratio = 2.80, 95% CI [1.34-5.98] and OR=2.15, 95% CI [1.18-4.39 respectively]; P = 0.015). The cumulative risk of MACE at six months was 33% for RV-LSF < 20% and 9% for RV-LSF ≥ 20% (log-rank test P < 0.001).Conclusion: RVsD, defined by RV-LSF < 20%, is associated with an increased risk of MACE after STEMI.

Diversifying cardiac intensive care unit models: Successful example of an operating surgeon-led unit

ObjectiveThe intensivist-led cardiovascular intensive care unit model is the standard of care in cardiac surgery. This study examines whether a cardiovascular intensive care unit model that uses operating cardiac surgeons, cardiothoracic surgery residents, and advanced practice providers is associated with comparable outcomes. MethodsThis is a single-institution review of the first 400 cardiac surgery patients admitted to an operating surgeon-led cardiovascular intensive care unit from 2020 to 2022. Inclusion criteria are elective status and operations managed by both cardiovascular intensive care unit models (aortic operations, valve operations, coronary operations, septal myectomy). Patients from the surgeon-led cardiovascular intensive care unit were exact matched by operation type and 1:1 propensity score matched with controls from the traditional cardiovascular intensive care unit using a logistic regression model that included age, sex, preoperative mortality risk, incision type, and use of cardiopulmonary bypass and circulatory arrest. Primary outcome was total postoperative length of stay. Secondary outcomes included postoperative intensive care unit length of stay, 30-day mortality, 30-day Society of Thoracic Surgeons–defined morbidity (permanent stroke, renal failure, cardiac reoperation, prolonged intubation, deep sternal infection), packed red cell transfusions, and vasopressor use. Outcomes between the 2 groups were compared using chi-square, Fisher exact test, or 2-sample t test as appropriate. ResultsA total of 400 patients from the surgeon-led cardiovascular intensive care unit (mean age 61.2 ± 12.8 years, 131 female patients [33%], 346 patients [86.5%] with European System for Cardiac Operative Risk Evaluation II <2%) and their matched controls were included. The most common operations across both units were coronary artery bypass grafting (n = 318, 39.8%) and mitral valve repair or replacement (n = 238, 29.8%). Approximately half of the operations were performed via sternotomy (n = 462, 57.8%). There were 3 (0.2%) in-hospital deaths, and 47 patients (5.9%) had a 30-day complication. The total length of stay was significantly shorter for the surgeon-led cardiovascular intensive care unit patients (6.3 vs 7.0 days, P = .028), and intensive care unit length of stay trended in the same direction (2.5 vs 2.9 days, P = .16). Intensive care unit readmission rates, 30-day mortality, and 30-day morbidity were not significantly different between cardiovascular intensive care unit models. The surgeon-led cardiovascular intensive care unit was associated with fewer postoperative red blood cell transfusions in the cardiovascular intensive care unit (P = .002) and decreased vasopressor use (P = .001). ConclusionsIn its first 2 years, the surgeon-led cardiovascular intensive care unit demonstrated comparable outcomes to the traditional cardiovascular intensive care unit with significant improvements in total length of stay, postoperative transfusions in the cardiovascular intensive care unit, and vasopressor use. This early success exemplifies how an operating surgeon-led cardiovascular intensive care unit can provide similar outcomes to the standard-of-care model for patients undergoing elective cardiac surgery.