Difference In Short-term Survival Research Articles

Clinical outcomes of aortic root repair using pericardial autograft for acute type a aortic dissection

BackgroundFor acute type A aortic dissection involving the aortic root with root diameter no more than 45 mm, there are various aortic root repair techniques. In this study, a novel surgical technique using a pericardial autograft for aortic root repair was introduced. We described its surgical steps in detail and compare its clinical outcomes with direct suture technique.MethodsBetween July 2017 and August 2022, 95 patients with acute type A aortic dissection who underwent aortic root repair were enrolled, including aortic root repair using pericardial autograft (group A, n = 49) or direct suture (group B, n = 46). The patient’s clinical data were retrospectively analyzed, and a 5-year follow-up was conducted.ResultsThe 30-day mortality, re-exploration for bleeding, postoperative new-onset renal failure requiring continuous renal replacement therapy, stroke, and paraplegia occurred in 3%, 4%, 11%, 5%, and 2% of the overall patients, respectively. There was no significant difference in the 30-day mortality and complication rate between the two groups. The 30-day mortality and re-exploration for bleeding marked the primary endpoint events. Logistic regression analysis indicated that there was a significant correlation between the primary endpoint events and surgical technique (odds ratio, 0.002; 95% confidence interval, 0-0.159; P = 0.026). The aortic valve insufficiency of the two groups were significantly improved after operation (group A, P < 0.001; group B, P < 0.001). During follow-up, there was no significant difference in short-term survival between the two groups after surgery (log-rank P = 0.75), and all patients were free from reoperation for aortic disease.ConclusionsPatients who underwent aortic root repair using pericardial autograft tended to have reduced 30-day mortality and a lower risk of re-exploration for bleeding. Using pericardial autograft for aortic root repair is a safe and useful approach for patients with acute type A aortic dissection involving the aortic root.

Sex-based differences in short-term survival following out-of-hospital cardiac arrest

Abstract Background Survival among OHCA patients remains low, thus it is important to understand the difference in short-term survival according to sex to identify subgroups of OHCA that could benefit from future preventive strategies. Purpose To examine sex differences in patient characteristics and the 30-day survival in patients with OHCA during 20 years of follow-up. Methods The study was observational and register-based, using information from the Danish Cardiac Arrest Registry (2001-2020) and linking at an individual level to other Danish national registers. Patients between 18-100 years old, with a presumed cardiac cause of OHCA, and not witnessed by emergency medical services (EMS) during their OHCA were identified. Baseline characteristics were expressed as medians (interquartile range [IQR]) or frequencies (percentages), and temporal trend analyses of 30-day survival were performed according to sex. Results We included 50,270 OHCA patients between 2001-2020 (17,179 [34%] women). Compared to men, women were older, with a median age of 76 years (Q1-Q3: [66-84]), had a higher proportion with a basic education level, and low-income. They also had a higher burden of comorbidities such as respiratory (38% vs. 32%; p&amp;lt;0,001), especially chronic obstructive pulmonary disease (COPD,19% vs. 14%; p&amp;lt;0,001), and a higher burden of psychiatric disease (13% vs. 8%; p&amp;lt;0,001). Related to medication 180 days before OHCA, women compared to men had more prescriptions of antibiotics (47.5% vs. 34.9%; p&amp;lt;0,001), steroids (18% vs. 13%; p&amp;lt;0,001), and QT-prolonging drugs (17% vs. 11%; p&amp;lt;0,001). By contrast, men had more cardiac-related comorbidities, especially ischemic heart disease (24% vs. 17%; p&amp;lt;0,001), and accordingly a higher prescription of anticoagulant drugs (17% vs. 13%; p&amp;lt;0,001), and statins (32% vs. 25%; p&amp;lt;0,001). Concerning cardiac arrest-related factors, women had more OHCA in a private home, less witnessed, were less likely to receive cardio-resuscitation and defibrillation and had less shockable rhythm. Figure 1 shows the temporal trend of OHCA incidence and 30-day survival by sex during 2001-2020. Although there has been an increase in survival for both sexes, women had lower 30-day survival compared to men throughout the period study. The average 30-day survival by sex during 2001-2010 vs. 2011-2020 was, for women 4.7% vs 8.2% and for men 8.1% vs 15.4%. Conclusions From 2001 to 2020, there was an increase in the 30-day survival in both sexes. However, the survival discrepancies increased between the sexes, where women had less shockable rhythm and lower 30-day survival compared to men.

Sex-Based Differences in Short-Term Survival Following Out-of-Hospital Cardiac Arrest

Sex-Based Differences in Short-Term Survival Following Out-of-Hospital Cardiac Arrest

Prognostic significance of time trends in treatment of head and neck squamous cell carcinoma

PurposeTo analyze the impact of demographic, clinical, and management variables on time to treatment initiation (TTI) and overall survival (OS). Study designRetrospective chart review. Materials and methodsMedical records of patients diagnosed with head and neck cancer from 2018 to 2020 were reviewed. Univariate linear and Cox-regressions identified predictors of TTI and OS. Kaplan Meier (KM) curves assessed the difference in survival by diagnostic year and TTI. Results381 patients met eligibility criteria. Median TTI was 35.0 days (IQR: 25.0–49.0). Only 10.8 % of all patients reported any treatment delay, with TTI exceeding 90 days found in 3.7 % of patients. TTI increased with African American race (p = 0.02), ED referrals (p = 0.02), and direct admission status (p = 0.01). When compared to treatment with surgery alone, TTI was shorter in patients undergoing surgery with adjuvant radiation (p = 0.02), adjuvant chemoradiation (p = 0.04), and salvage surgery (p = 0.04). Univariate Cox-regressions found smoking (p = 0.01), direct admission status (p = 0.02), increased duration of symptoms (p = 0.02), placement of PEG tubes (p < 0.01) and tracheostomies (p < 0.01), combination treatment (p < 0.01), and surgery with adjuvant chemoradiation treatment (p = 0.01) to increase mortality risk. Disease characteristics, including tumor size (p < 0.01), presence of nodal disease (p = 0.02), and late-stage disease (p < 0.01), increased mortality risk. TTI and diagnostic year did not impact survival. ConclusionsOur analysis determined several demographic, referral, and treatment factors impacted TTI. However, increased TTI did not impact survival. Characteristics consistent with advanced disease worsened OS. Despite the pandemic burden, patients diagnosed in 2020 showed no difference in short-term survival compared to prior years.

Positive donor blood cultures are not associated with worse heart transplant survival.

Recent evidence has demonstrated that transplantation of hearts with blood culture positive donors (BCPDs) to pediatric recipients is safe and effective. Few studies have analyzed the effect of BCPD on adult heart transplant recipients. The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from September, 1987 to March, 2021. Exclusion criteria included pediatric donors/recipients, donor ejection fraction <10% or >85%, inactive listed recipients, donors missing blood cultures, and recipients missing follow-up time. Outcomes were compared with fully adjusted logistic models. To account for discrepancies in BCPD and non-BCPD covariates, an inverse proportionally weighted model with regression adjustment (IPWRA) was used. A total of 60592 donors were non-BCPD, while 4009 were BCPD. 7% of hearts not transplanted were BCPD, while 6% of hearts transplanted were BCPD (p=.001). These rates have been nearly constant since 2005. There were no differences in short term survival between the two groups in the adjusted or IPWRA models (p=.103 and .277, respectively). Additionally, the BCPD group had longer ischemic time (3.24 vs. 3.06h, p<.001), older donor age (32.73 vs. 31.65years, p<.001), and older recipient age (52.76 vs. 52.09years, p=.001). The IPWRA revealed an average additional 3.4years of overall survival and 2.25years of graft function for BCPD versus non-BCPD recipients, although these results failed to reach statistical significance (p=.387 and .527, respectively). Given the need for more donor hearts, donors with positive blood cultures should be considered. Great care in evaluating such patients is advised to eliminate donors with untreated infections, while carefully selected donors can be considered and used.

Liver Transplantation in Rescue Allocation: Comparison of the Donor Risk Index, Balance of Risk Score and Graft Function After Liver Transplantation

Background: In the model for end-stage liver disease (MELD) system, the use of livers from rescue allocation (RA), those refused for the first five of the ranking, have conflicting results in the literature. Objective: Analysis of the characteristics of the different simulated patterns of allocation (pattern vs. rescue), using the donor risk index (DRI), the balance of risk score (BAR) and its impact on the graft function. Method: Cohort of 233 liver transplants in adults, performed between 2015 and 2022. Results: General characteristics, age 50.3 ± 11.8 years; 64.81% CHILD C; MELD in allocation 22.4 ± 7.6. Initial graft dysfunction in 12.45% and primary nonfunction (PNF) in 8.15%; with DRI 1.41 ± 0.32. Transplants in RA occurred in 18.03% (n = 42) of cases, in patients with significantly lower MELD (18.4 ± 4.8) and BAR (7.1 ± 3.2) compared to standard allocation (23.2 ± 7.9; 9.2 ± 4.2 respectively). The DRI was significantly higher (p = 0.001) in the RA (1.58 ± 0.37). Age (p = 0.23) and body mass index (p = 0.85) of the donor, cold ischemia time (CIT) (p = 0.10) showed no differences between the groups. RA organs came more often from out-of-state (50% vs. 2.62%) and less harvested by our surgical team (38.1% vs. 79.0%). Early graft dysfunction (EGD) in 16.67% (n = 7); 14.29% (n = 6) of primary nonfunctioning in the RA group, percentage higher than in the standard allocation group with 11.52% (n = 22) and 6.81% (n = 13) respectively; however, there was no difference with statistical significance (p = 0.052). There was no difference in survival (73.81% vs. 72.25%; p = 0.83). Conclusion: A strategy more frequently employed in patients with less severe conditions according to BAR score, liver grafts in a RA rescue allocation system had higher DRI scores and did not provide a difference in short-term survival.

The Effects of Postacute Rehabilitation on Mortality, Chronic Care Dependency, Health Care Use, and Costs in Sepsis Survivors.

Rationale: Sepsis often leads to long-term functional deficits and increased mortality in survivors. Postacute rehabilitation can decrease long-term sepsis mortality, but its impact on nursing care dependency, health care use, and costs is insufficiently understood. Objectives: To assess the short-term (7-12 months postdischarge) and long-term (13-36 months postdischarge) effect of inpatient rehabilitation within 6 months after hospitalization on mortality, nursing care dependency, health care use, and costs. Methods: An observational cohort study used health claims data from the health insurer AOK (Allgemeine Ortskrankenkasse). Among 23.0 million AOK beneficiaries, adult beneficiaries hospitalized with sepsis in 2013-2014 were identified by explicit codes from the International Classification of Diseases, Tenth Revision. The study included patients who were nonemployed presepsis, for whom rehabilitation is reimbursed by the AOK and thus included in the dataset, and who survived at least 6 months postdischarge. The effect of rehabilitation was estimated by statistical comparisons of patients with rehabilitation (treatment group) and those without (reference group). Possible differential effects were investigated for the subgroup of ICU-treated sepsis survivors. The study used inverse probability of treatment weighting based on propensity scores to adjust for differences in relevant covariates. Costs for rehabilitation in the 6 months postsepsis were not included in the cost analysis. Results: Among 41,918 6-month sepsis survivors, 17.2% (n = 7,224) received rehabilitation. There was no significant difference in short-term survival between survivors with and without rehabilitation. Long-term survival rates were significantly higher in the rehabilitation group (90.4% vs. 88.7%; odds ratio [OR] = 1.2; 95% confidence interval [95% CI] = 1.1-1.3; P = 0.003). Survivors with rehabilitation had a higher mean number of hospital readmissions (7-12 months after sepsis: 0.82 vs. 0.76; P = 0.014) and were more frequently dependent on nursing care (7-12 months after sepsis: 47.8% vs. 42.3%; OR = 1.2; 95% CI = 1.2-1.3; P < 0.001; 13-36 months after sepsis: 52.5% vs. 47.5%; OR = 1.2; 95% CI = 1.1-1.3; P < 0.001) compared with those without rehabilitation, whereas total health care costs at 7-36 months after sepsis did not differ between groups. ICU-treated sepsis patients with rehabilitation had higher short- and long-term survival rates (short-term: 93.5% vs. 90.9%; OR = 1.5; 95% CI = 1.2-1.7; P < 0.001; long-term: 89.1% vs. 86.3%; OR = 1.3; 95% CI = 1.1-1.5; P < 0.001) than ICU-treated sepsis patients without rehabilitation. Conclusions: Rehabilitation within the first 6 months after ICU- and non-ICU-treated sepsis is associated with increased long-term survival within 3 years after sepsis without added total health care costs. Future work should aim to confirm and explain these exploratory findings.

SINGLE CENTRE COMPARISON OF PATIENTS MANAGED BY A CODE SHOCK TEAM VERSUS STANDARD OF CARE

SINGLE CENTRE COMPARISON OF PATIENTS MANAGED BY A CODE SHOCK TEAM VERSUS STANDARD OF CARE

Donor Positive Blood Cultures Do Not Impact Adult Heart Transplant Survival

<h3>Purpose</h3> Recent studies have examined the effect of blood culture positive donors (BCPD) on transplantation. To our knowledge, no one has completed an analysis on the effect of BCPD on adult heart transplant recipients. <h3>Methods</h3> The United Network for Organ Sharing (UNOS) database was retrospectively reviewed from September 1987 to March 2021 . Pediatric donors/recipients, ejection fraction <10 or >85, inactive listed recipients, donor missing blood cultures, and recipients missing follow up time were excluded. Outcomes were compared with fully adjusted logistic models. To account for discrepancies in BCBP and non-BCPD covariates, an inverse proportionally weighted model with regression adjustment (IPWRA) was used. <h3>Results</h3> 60,592 donors were non-BCPD, while 4,009 were BCPD. The difference in transplantation in BCPD (6%) versus non-BCPD (7%) was small (p = 0.001). These rates have been nearly constant since 2005. There were no differences in short term survival between the two groups in the adjusted or IPWRA models (p = 0.112 and 0.316, respectively). In adjusted models, there was slight indication that BCPD may have higher hazard of death and graft failure, but these also failed to reach statistical significance (both p >0.05). Additionally, the BCPD group had longer ischemic time, older donor and recipient age, donor and recipient racial differences, more intra-aortic balloon pumps, and more donor and recipient diabetes (p <0.05 for all). Thus, examining the IPWRA results, we see an average additional 3.37 years of overall survival and 2.25 years of graft function for BCPD, although these results also failed to reach statistical significance (p = 0.371 and 0.515, respectively). <h3>Conclusion</h3> Given the need for more donor hearts, donors with positive blood cultures should be considered. Great care in evaluating such patients is advised to eliminate donors with untreated infections, while carefully selected cases can be used.

Check the Need-Prevalence and Outcome after Transvenous Cardiac Implantable Electric Device Extraction without Reimplantation.

Background: after transvenous lead extraction (TLE) of cardiac implantable electric devices (CIEDs), some patients may not benefit from device reimplantation. This study sought to analyse predictors and long-term outcome of patients after TLE with vs. without reimplantation in a high-volume centre. Methods: all patients undergoing TLE at our centre between January 2010 and November 2015 were included into this analysis. Results: a total of 223 patients (median age 70 years, 22.0% female) were included into the study. Cardiac resynchronization therapy-defibrillator (CRT-D) was the most common device (40.4%) followed by pacemaker (PM) (31.4%), implantable cardioverter-defibrillator (ICD) (26.9%), and cardiac resynchronization therapy-PM (CRT-P) (1.4%). TLE was performed due to infection (55.6%), malfunction (35.9%), system upgrade (6.7%) or other causes (1.8%). In 14.8%, no reimplantation was performed after TLE. At a median follow-up of 41 months, no preventable arrhythmia-related events were documented in the no-reimplantation group, but 11.8% received a new CIED after 17–84 months. While there was no difference in short-term survival, five-year survival was significantly lower in the no-reimplantation group (78.3% vs. 94.7%, p = 0.014). Conclusions: in patients undergoing TLE, a re-evaluation of the indication for reimplantation is safe and effective. Reimplantation was not related to preventable arrhythmia events, but all-cause survival was lower.

Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis.

To examine whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) improves survival of patients with acute pulmonary embolism (PE). Following the PRISMA guidelines, a systematic search was conducted up to August 2019 of the databases: PubMed/MEDLINE, EMBASE and Cochrane. All studies reporting the survival of adult patients with acute PE treated with VA-ECMO and including four patients or more were included. Exclusion criteria were: correspondences, reviews and studies in absence of a full text, written in other languages than English or Dutch, or dating before 1980. Short-term (hospital or 30-day) survival data were pooled and presented with relative risks (RR) and 95% confidence intervals (95% CI). Also, the following pre-defined factors were evaluated for their association with survival in VA-ECMO treated patients: age > 60 years, male sex, pre-ECMO cardiac arrest, surgical embolectomy, catheter directed therapy, systemic thrombolysis, and VA-ECMO as single therapy. A total of 29 observational studies were included (N = 1947 patients: VA-ECMO N = 1138 and control N = 809). There was no difference in short-term survival between VA-ECMO treated patients and control patients (RR 0.91, 95% CI 0.71-1.16). In acute PE patients undergoing VA-ECMO, age > 60 years was associated with lower survival (RR 0.72, 95% CI 0.52-0.99), surgical embolectomy was associated with higher survival (RR 1.96, 95% CI 1.39-2.76) and pre-ECMO cardiac arrest showed a trend toward lower survival (RR 0.88, 95% CI 0.77-1.01). The other evaluated factors were not associated with a difference in survival. At present, there is insufficient evidence that VA-ECMO treatment improves short-term survival of acute PE patients. Low quality evidence suggest that VA-ECMO patients aged ≤60 years or who received SE have higher survival rates. Considering the limited evidence derived from the present data, this study emphasizes the need for prospective studies. PROSPERO CRD42019120370.

The impact of heart disease on postoperative complications after pancreaticoduodenectomy

Purpose: Comorbidity increases the risk for postoperative complications after pancreatic surgery. However, the impact of different heart diseases on postoperative outcome after pancreaticoduodenectomy (PD) has not been thoroughly studied. Methods: All patients aged ≥18 years who underwent PD (2008 – 2019) at Karolinska University Hospital were retrospectively analysed. Heart disease was defined as presence of a preoperative cardiac diagnosis (according to the International Statistical Classification of Diseases and Related Health Problems, ICD, 10th version) and categorised in groups: atrial fibrillation, heart failure, ischemic heart disease and valvular disease. Postoperative morbidity and mortality were analysed by multivariable logistic regression. Results: Overall, 971 patients were included and 225 had at least one preoperative cardiac diagnosis. Heart disease was associated with increased risk of Clavien-Dindo ≥ IIIa (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.07-2.18; p=0.019), longer median hospital stay (14 vs. 11 days; p<0.001), risk of intensive care unit (ICU) admission (OR 3.20, 95% CI 1.81-5.66; p<0.001) and delayed gastric emptying grade B-C (OR 1.45, 95% CI 1.03-2.04; p=0.031). There was no difference in 30-day mortality, however, patients with heart disease had a shorter median overall survival (22 vs. 32 months; p<0.001). Atrial fibrillation, heart failure and ischemic heart disease were independently associated with increased risk for complications whereas valvular disease was not. Conclusion: Ischemic heart disease, atrial fibrillation and heart failure was associated with increased risk for postoperative complications after PD. No difference in short term survival was observed but patients with heart disease had a shorter median overall survival.

Long-Term Survival After Heart Transplantation at Centers Stratified by Short-Term Performance.

Center differences in short-term survival after heart transplant (HT) are known. We sought to compare long-term graft survival (freedom from death or retransplantation) at currently active United States HT centers stratified by performance for short-term survival. We used the Organ Procurement and Transplant Network database to identify subjects ≥18 years old who received primary HT during 2000 to 2014 at US centers active during 2013 and 2014. Follow-up was available until March 2016. Center case-mix was assessed by computing expected 90-day mortality and short-term performance by 90-day standardized mortality ratio (SMR; observed/expected mortality). Centers were stratified by case-mix as transplanting low-, intermediate-, and high-risk patients and by short-term performance as SMR quintiles. Center-level differences in long-term graft survival were assessed by risk-adjusted, mixed-effects Weibull survival models with center as a random effect. We analyzed 25 467 HT recipients at 96 centers. Those receiving HT at centers with superior (lower) 90-day SMR had longer graft survival (P for trend <0.001). Survival difference among SMR groups remained significant in 90-day conditional survivors (P for trend <0.001). There was significant center-level variation in risk-adjusted graft survival censored at 5 years (P<0.001) and with all follow-up (P<0.001). Adjusting for 90-day SMR was associated with 62% reduction in center variation in 5-year graft survival and 56% reduction in center variation in overall graft survival. HT recipients at centers with superior short-term outcomes have longer graft survival on long-term follow-up. Allocating resources to improve patient care processes and transplant expertise at high-SMR centers may improve short-term and overall survival after HT.

Ethnic Variations in Systemic Sclerosis Disease Manifestations, Internal Organ Involvement, and Mortality.

A multiethnic systemic sclerosis (SSc) cohort study to evaluate ethnic variations in disease manifestations, internal organ involvement, and survival. Adults who fulfilled the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc between 1970 and 2017 were included. Self-reported ethnicity was categorized as European-descent white, Afro-Caribbean, Hispanic, Arab, East Asian, South Asian, First Nations, or Persian. The primary outcome was the time from diagnosis to death from all causes. Survival probabilities and median survival times were determined using Kaplan-Meier survival curves. There were 1005 subjects evaluated, the majority of whom were European-descent white (n = 745, 74%), Afro-Caribbean (n = 58, 6%), South Asian (n = 70, 7%), and East Asian (n = 80, 8%). Compared to European-descent white subjects, East Asians less frequently had calcinosis (29% vs 9%, p = 0.002) and esophageal dysmotility (88% vs 69%, p = 0.002); Afro-Caribbeans more frequently had interstitial lung disease (31% vs 53%, p = 0.007); and First Nations subjects more frequently had diffuse cutaneous disease (35% vs 56%, p = 0.02) and diabetes (5% vs 33%, p = 0.03). We found no difference in the short-term survival across ethnicities. Hispanic subjects have better longterm survival (81.3%, 95% CI 63-100) compared to European-descent white subjects (55%, 95% CI 51-60). East Asians appear to have the longest median survival time (43.3 yrs) and Arabs the shortest median survival time (15 yrs). There was no significant difference in median survival times between Afro-Caribbean and European-descent white subjects (22.2 vs 22.6 yrs). Ethnic variations in some SSc disease manifestations are observed. However, this does not result in significant differences in short-term survival but may affect longterm survival.

Biodeposits from Mytilus edulis: a potentially high-quality food source for the polychaete, Hediste diversicolor

Previous studies have shown clearly that the deposit feeding polychaete, Hediste diversicolor, can promote oxygenation of sediments exposed to excess loads of mussel faeces. In this experimental study, we explicitly test their utility as food for H. diversicolor to survive and grow on. Furthermore, in order to understand the consequences of experimental manipulations, we also evaluated effects on chemical fluxes in and out of the sediment. The results show strong differences in growth but no difference in short-term survival. Fed only on mussel faeces, the polychaetes grew on average 17% in wet weight after a period of 10 days, compared to 3% when given equivalent amounts of organic matter from the natural sediments. Addition of faeces to natural sediments resulted in 19–20% growth, thus suggesting an approximate additive effect of the two food sources. Chemical analyses showed that, oxygen consumption increased with load of organic material irrespective of origin, faecal material caused higher fluxes of ammonia compared to natural organic material, but neither oxygen consumption nor nutrient fluxes were affected by the ashing of sediments. In contrast, fluxes of silicate increased as a consequence of ashing but were not affected by the addition of mussel faeces. Thus, despite risks of experimental artefacts due to ashing of sediments, the results show that oxygen and nutrient dynamics responded to manipulations of organic material and not to the potential modification of sediment structure. Therefore, the observed effects on growth of H. diversicolor can be safely interpreted as caused by differences in amount and quality of organic material. Mussel faeces is a high-quality food source for this species of polychaete and, in combination with ample evidence from previous studies that bioturbation, we conclude that H. diversicolor is a suitable candidate in further efforts to develop technical solutions based on bioturbation for mitigation of adverse effects on benthic environments in connection with mussel-farming.

Bronchial Artery Embolization in the Management of Hemoptysis in Patients with Hematologic Diseases: Feasibility and Short-Term Efficacy

Background: Patients with hematologic diseases are frequently accompanied by coagulopathy; even a small amount of hemoptysis may worsen clinical outcomes compared to those with the similar severity of injury without coagulopathy. However, a few studies have included various hematologic conditions, and none of them were large series. Objectives: To evaluate the feasibility and short-term efficacy of bronchial artery embolization (BAE) in the management of hemoptysis in patients with hematologic diseases. Patients and Methods: This was a retrospective study of 25 patients with hematologic diseases who visited our interventional unit for the management of hemoptysis between 2009 and 2012. The clinical, laboratory, and radiographic data were retrospectively analyzed and we correlated clinical response with the amount of hemoptysis, coagulation condition, radiographic pattern, and bronchial artery hypertrophy. Results: The amount of hemoptysis was trivial in 13 patients (52 %), moderate in ten patients (40%), and massive in two patients (8%). Thirteen patients (52%) had coagulopathy (platelet count 1.5). Seventeen patients (68%) showed focal pulmonary hemorrhagic patterns and eight patients (32%) showed diffuse pulmonary hemorrhagic patterns. BAE provided complete clinical response in 21 out of 25 patients (84%). Complete clinical response was not correlated with the amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy (P > 0.05). There was no significant difference in short-term survival between patients with coagulopathy and those without coagulopathy (P = 0.425), and between patients with focal hemorrhagic pattern and those with diffuse hemorrhagic pattern (P = 0.728). Conclusion: BAE in hematology patients was relatively efficient in controlling hemoptysis. The amount of hemoptysis, coagulation condition, radiographic pattern, or bronchial artery hypertrophy was not a significant factor affecting the outcome.

Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study

BackgroundThe effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS.MethodsData were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran–Mantel–Haenszel methods and mixed-effects models.ResultsEight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4–5.4).ConclusionsOur results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients.Trial registrationClinicaltrials.gov Identifier: NCT01502111. Registered 22 Desember 2011.

Terapia renal en pacientes con fracaso renal agudo en Unidad de Cuidados Intensivos, terapia de reemplazo renal continua, intermitente prolongada e intermitente: estudio de supervivenci

BackgroundAcute kidney injury (AKI) is a common complication in hospitalized patients, and is an independent predictor of mortality. Approximately 4-5% of patients in ICU will need renal replacement therapy (RRT), and more than two-thirds of these patients will develop AKI, with a mortality of 50 to 60%. Although continuous renal replacement therapy (CRRT) is the preferred treatment in patients with AKI in ICU, especially if there is hemodynamic instability, no differences in survival compared to intermittent hemodialysis (IHD) or hybrid therapies, such as prolonged intermittent renal replacement therapies (PIRRT), have been demonstrated. ObjectiveTo describe our experience with different renal replacement therapies and the survival of our patients. HypothesisThere is no difference in short-term survival between patients with AKI or acute chronic disease who required RRT, such as CRRT or hybrid therapy, than those who were treated using intermittent hemodialysis (IHD). MethodsA retrospective study was conducted from March 2009 to June 2012 on all patients who were treated with RRT in ICU, with survival being assessed after 28 days follow-up. Results and conclusionsThe study included a total of 33 patients, of whom 20 were male and 13 females. They were divided into therapy groups, with 21 for CRRT, 6 for hybrid therapies, and 6 de IHD. The percentage survival was 28.6% for CRRT, 16.7% for hybrid, and 33.3% for IHD.It could not be demonstrated that there was a greater survival in any of the therapies in this study.

Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept

Much controversy exists about who can provide the best medical care for critically ill patients in the prehospital setting. The Anglo-American concept is on the whole to provide well trained paramedics to fulfil this task, whereas in some European countries emergency medical service physicians, particularly anaesthesiologists, are responsible for the safety of these patients. Currently there are no convincing level I studies showing that an emergency physician-based emergency medical service leads to a decrease in overall mortality or morbidity of prehospital treated patients, but many methodical, legal and ethical issues make such studies difficult. Looking at specific aspects of prehospital care, differences in short-term survival and outcome have been reported when patients require cardiopulmonary resuscitation, advanced airway management or other invasive procedures, well directed fluid management and pharmacotherapy as well as fast diagnostic-based decisions. Evidence suggests that some critically ill patients benefit from the care provided by an emergency physician-based emergency medical service, but further studies are needed to identify the characteristics and early recognition of these patients.

The Effect of Adenosine A1 Receptor Antagonism on Return of Spontaneous Circulation andShort-Term Survival in Prolonged Ventricular Fibrillation

Background. Endogenous adenosine (ADO) is cardioprotective during ischemia andits myocardial concentration increases during untreated ventricular fibrillation (VF). We have previously shown that ADO A1 receptor (ADOA1R) antagonism hastens the time-dependent decay in VF waveform morphology during the circulatory phase of cardiac arrest. Objective. To determine the effect of ADOA1R antagonism on ROSC andshort-term survival in prolonged VF. Methods. Thirty-six swine were assigned by block randomization to one of three groups: a group that received only vehicle (control), an ADOA1R antagonist pretreatment group (pre), anda group that was given ADOA1R antagonist during resuscitation (during). The animals were instrumented under anesthesia, andADOA1R antagonist or vehicle, per group assignment, was infused 5 minutes prior to VF induction. At minute 8 of untreated VF, chest compression with ventilation was initiated anda standard drug cocktail, with ADOA1R antagonist or vehicle, was given. The first rescue shock (150 J biphasic) was delivered after 11 minutes of VF. Proportions with 95% confidence intervals (CIs) were calculated for the two outcome measures. Results. The baseline characteristics andchemistry values for the three groups were mathematically the same. The during group had a greater proportion of female animals (seven of 12) in comparison with the control group (two of 12) (p = 0.03). ADOA1R antagonism hastened the decay of VF as previously demonstrated, but the rate of ROSC was the same for all groups: control = seven of 12, pre = six of 12, andduring = seven of 12. There were also no differences in short-term survival: control = four of 12, pre = five of 12, andduring = seven of 12. Conclusions. In this study, ADOA1R antagonism had no effect on outcome whether given before induction of VF or upon resuscitation after 8 minutes of untreated VF. The role of endogenous ADO in prolonged VF remains unclear.