Cardiac Arrest Research Articles

Which Matters More for Out-of-Hospital Cardiac Arrest Survival: Witnessed Arrest or Bystander Cardiopulmonary Resuscitation?

Despite the well-known importance of witnessed arrest and bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest outcomes, previous studies have shown significant statistical inconsistencies. We hypothesized an interaction effect and conducted stratified analyses to investigate whether witnessed arrest is more important than bystander CPR. This study enrolled patients with out-of-hospital cardiac arrest between January 2010 and December 2022 in 3 emergency medical service (systems in Taiwan). Data were extracted from emergency medical service dispatch reports, including patient characteristics, witnessed arrest, bystander CPR, time for each dispatch, and prehospital interventions. The outcome measure was prehospital return of spontaneous circulation (ROSC). Patients were categorized into 4 groups: witnessed and bystander CPR present (W+B+), witnessed present but bystander CPR absent (W+B-), witnessed absent but bystander CPR present (W-B+), and witnessed and bystander CPR absent (W-B-). Multiple logistic regression on prehospital ROSC were performed in the 4 subgroups separately. A total of 14 737 patients with out-of-hospital cardiac arrest were identified, of whom 977 (6.6%) achieved prehospital ROSC. The W+B+ group exhibited the highest prehospital ROSC rate (14.0%). Stratification confirmed a statistically significant interaction between witnessed arrest and bystander CPR. Defibrillation, endotracheal intubation, and epinephrine administration were significantly associated with prehospital ROSC in all subgroups. Most explanatory variables significant in the witnessed arrest group were adjusted for in the nonwitnessed arrest group. Younger age was associated with prehospital ROSC only in the W+B+ group. Witnessed arrest and bystander CPR may interact to predict prehospital ROSC in out-of-hospital cardiac arrest, with witnessed arrest likely having more significant impact on outcomes.

Ethylene Glycol Poisoning Complicated by Cardiac Arrest and a Raised Lactate Gap: A Case Report

Ethylene Glycol Poisoning Complicated by Cardiac Arrest and a Raised Lactate Gap: A Case Report

Mesenchymal stem cells-derived exosomes attenuate mouse non-heart-beating liver transplantation through Mir-17-5p-regulated Kupffer cell pyroptosis

BackgroundLiver transplantation is the most effective treatment for end-stage liver disease. However, the shortage of donor livers has become a significant obstacle to the advancement of liver transplantation. Mesenchymal stem cells-derived exosomes (MSCs-Exo) have been extensively investigated in liver diseases. However, the underlying mechanisms of how they can protect organ donation after cardiac death (DCD) livers remain unclear.MethodsIn this study, an arterialized mouse non-heart-beating (NHB) liver transplantation model was used to investigate the effect of MSCs-Exo on NHB liver transplantation. The survival rates, histology, pro-inflammatory cytokine and chemokine expression, and underlying mechanisms were investigated.ResultsThe infusion of MSCs-Exo reduced the injury to DCD liver graft tissue. In vitro and in vivo experiments demonstrated that MSCs-Exo could inhibit hydrogen peroxide-induced pyroptosis of Kupffer cells. We found that miR-17-5p was significantly abundant in MSCs-Exo, targeting and regulating the TXNIP expression. This action inhibited NLRP3-mediated pyroptosis of Kupffer cells through the classical Caspase1-dependent pathway, alleviating DCD liver graft injury.ConclusionOur study elucidated a protective role for MSCs-Exo in a NHB liver transplantation model. This mechanism provides a theoretical basis and new strategies for the clinical application of MSCs-Exo to improve liver graft quality and alleviate the organ shortage in liver transplantation.

Topological Distribution of KCNH2 Variants and Genotype-Phenotype Relationship in Patients With Long QT Syndrome.

The aim of this study was to investigate the topological distribution of single nucleotide variants (SNVs) in the KCNH2 gene from patients with type 2 long QT syndrome (LQT2) and to explore the genotype-phenotype relationships. Information on KCNH2 variants in LQT2 patients was retrospectively obtained from the HGMD, ClinVar, and PubMed databases through October 2022. Pathogenicity of SNV was classified according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Unpaired t-tests and Fisher's exacts were used to analyze the SNV distributions across structural and functional domains, and their correlation with clinical phenotypes. A total of 2826 variants were obtained; 2152 were SNVs, 1328 of which were nonsynonymous SNVs (nsSNVs) associated with LQT2. Enrichment analysis revealed that 602 pathogenic (P) and likely pathogenic (LP) nsSNVs were significantly enriched at S5, H5, S6, Extra3, and Extra4. In addition, 759 nsSNVs and 289 P/LP nsSNVs within function domain were enriched at the per-arnt-sim (PAS) and selectivity filter (SF) functional domain. Clinical data revealed that patients with nsSNVs enriched at the N-terminal, S5-H5-S6 region and PAS domain were associated with an increased risk of syncope. Moreover, nsSNVs located at the N-terminal, S5-H5-S6 region, and PAS, SF domains were associated with an increased risk of life-threatening cardiac events, including Torsade de Pointes (TdP) and sudden cardiac death (SCD), and were predominantly female. KCNH2 nsSNVs located at the N-terminal, S5-H5-S6 region, and the PAS and SF functional domains are associated with an increased risk of life-threatening cardiac events in LQT2 patients.

Improving quality and outcomes of extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest: the Phoenix ECPR project

BackgroundSurvival for cardiac arrest remains poor, and the use of extracorporeal cardiopulmonary resuscitation (ECPR) has been suggested as a potential therapy to improve outcomes. Harefield Hospital has been performing ECPR...

Decreased Left Ventricular Systolic Function during the Late Phase after Response to Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) improves cardiac function in patients with heart failure (HF) and dyssynchrony. However, a subset of responders develops a delayed decline in left ventricular (LV) systolic function, referred to as "delayed negative reverse remodeling (DNRR)." This study aimed to investigate the characteristics and prognosis of DNRR in CRT responders. A total of 203 patients undergoing CRT device implantation were analyzed. Among them, 100 responders were identified based on a ≥5% absolute LV ejection fraction (LVEF) increase and a ≥15% relative LV end-systolic volume (LVESV) reduction at 6 months post-CRT. DNRR was defined as a ≥5% absolute decrease in LVEF at 1 year after treatment response determination. Of the responders, 22 (22.0%) exhibited DNRR, while 78 (78.0%) were classified as non-DNRR. The DNRR group showed a decline in LVEF from 41.2±8.3% to 32.7±9.6% (p<0.001), while the non-DNRR group showed improvement from 42.8±9.5% to 46.2±10.5% (p<0.001). Multivariate analysis identified LVESV ≥100 mL (odds ratio [OR]: 3.575, p=0.041), paced QRS duration ≥150 ms (OR: 4.427, p=0.023), synchronized LV pacing <85% (OR: 5.753, p=0.043) at 6 months post-CRT, and intraventricular conduction disturbance (OR: 5.593, p=0.018) as independent predictors of DNRR. The DNRR group had significantly worse outcomes, including cardiac death and HF-related hospitalization, compared to the non-DNRR group. Despite an initial response to CRT, a subset of HF patients developed DNRR, which correlated with worse clinical outcomes. Identifying risk factors associated with DNRR may help optimize CRT management and improve long-term patient care.

Potent P2Y12 inhibitors in patients with acute myocardial infarction and cardiogenic shock

BackgroundAlthough potent P2Y12 inhibitors, such as ticagrelor and prasugrel, are standard treatment in patients with acute myocardial infarction (AMI), evidence for their efficacy and safety compared with clopidogrel is limited in patients with AMI complicated by cardiogenic shock.MethodsAmong 28,949 patients from the nationwide pooled registry of KAMIR-NIH and KAMIR-V, a total of 1482 patients (5.1%) with AMI and cardiogenic shock who underwent percutaneous coronary intervention of the culprit vessel were selected. Primary outcome was major adverse cardiovascular event (MACE, a composite of cardiac death, MI, repeat revascularization and definite stent thrombosis) and major secondary outcome was Bleeding Academic Research Consortium (BARC) type 2 or greater bleeding at 2 years.ResultsAmong the study population, 537 patients (36.2%) received potent P2Y12 inhibitors and 945 patients (63.8%) received clopidogrel after index procedure. The risk of MACE was significantly lower in the potent P2Y12 inhibitors group than in the clopidogrel group (16.6% versus 24.7%; adjusted hazard ratio [HR], 0.76 [95% CI 0.59–0.99]; P = 0.046). Regarding BARC type 2 or greater bleeding, there was no significant difference between the potent P2Y12 inhibitors group and the clopidogrel group (12.5% versus 10.7%; adjusted HR, 1.36 [95% CI 0.98–1.88]; P = 0.064). Significant interaction was observed in patients aged ≥ 75 years (interaction P = 0.021) or venoarterial extracorporeal membrane oxygenator (VA-ECMO) use (interaction P = 0.015) for significantly increased risk of BARC type 2 or greater bleeding following the use of potent P2Y12 inhibitors.ConclusionsIn patients with AMI complicated by cardiogenic shock, the use of potent P2Y12 inhibitors was associated with a lower risk of MACE compared with clopidogrel, without an increased risk of BARC type 2 or greater bleeding. The current data supports the use of potent P2Y12 inhibitors in patients with AMI and cardiogenic shock, except in patients aged ≥ 75 years or receiving VA-ECMO support.Graphical abstract

Understanding cardiac arrest dispatch of physician-paramedic critical care prehospital teams: a survey-based evaluation

BackgroundAppropriate dispatch of critical care teams to out-of-hospital cardiac arrest (OHCA) has been identified as a research priority emergency care in the UK. The study aimed to understand the criteria...

Early Escalation to CentriMag for Acute Myocardial Infarction-Induced Out-of-Hospital Cardiac Arrest With Refractory to Extracorporeal Membrane Oxygen Support.

The mortality rate of acute myocardial infarction (AMI)-related refractory cardiogenic shock (rCS) remains high, particularly in patients experiencing cardiac arrest with extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to evaluate the outcomes of early escalation to CentriMag for AMI-induced out-of-hospital cardiac arrest (OHCA) with ECPR. Patients with AMI-induced OHCA with refractory to ECMO support after ECPR were enrolled. Clinical data were analyzed to identify predictive factors for mortality and survival benefits. Eighty-nine patients were enrolled, of whom 26 underwent CentriMag implantation. The 1-year survival rate for those with the implantation was 34.6%. In contrast, those without implantation showed a survival rate of 7.9%. The average time from the initiation of ECPR to CentriMag implantation was 22.5 ± 14.6 h. The surgical mortality group exhibited a larger body surface area, longer intervals from CPR to ECPR, shorter duration of CentriMag support, and higher preoperative serum creatinine and postoperative day 1 serum aspartate aminotransferase levels. A prolonged interval from CPR to ECPR was identified as an independent risk factor for mortality. Extended duration of CentriMag support was associated with improved survival outcomes. Early CentriMag implantation rescues patients experiencing AMI-related OHCA with rCS and refractory to ECMO support after ECPR. This intervention provides a critical time window, serving as a safe bridge to decision.

Heart disease in pregnancy and adverse outcomes: an umbrella review

BackgroundHeart disease in pregnancy encompasses both congenital heart disease and maternal-acquired heart disease, both of which are associated with an increased risk of various adverse outcomes for mothers and their offspring.ObjectiveThe objective of the study was to review and summarize the evidence regarding the association between heart disease in pregnancy and adverse outcomes in mothers and their offspring.Data sourcesA comprehensive search was conducted in Embase, PubMed, Web of Science, and the Cochrane Database of Systematic Reviews from inception to March 2024. The protocol for this review was registered in PROSPERO (CRD42024519144).Study eligibility criteriaThis review included systematic reviews and meta-analyses that examined the association between heart disease in pregnancy and adverse outcomes for mothers and their offspring.Study appraisal and synthesis methodsData were independently extracted by two reviewers. The quality of the systematic reviews and meta-analyses was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR2), while Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to evaluate the strength of the evidence for each outcome.ResultsA total of 12 meta-analyses and systematic reviews were included, which documented 156 adverse outcomes for mothers and 65 adverse outcomes for offspring. Evidence was found for both primary and secondary adverse outcomes. Adverse outcomes for mothers were death, cardiac events (cardiac arrest, heart failure, surgery, arrhythmia, anesthesia or sedation, endocarditis, mitral regurgitation, myocardial infarction, NYHA III–IV, restenosis, syncope, and others), pulmonary events (respiratory failure, pulmonary edema, and respiratory support), embolism, cerebrovascular events, postpartum hemorrhage, arterial events, delivery mode, and hospital stay. Adverse outcomes for offspring were death, pregnancy loss, growth restriction, low birth weight, preterm birth, recurrence, and uncertainty. No publication bias was detected using Egger’s test. The overall AMSTAR 2 confidence rating for the included meta-analyses and systematic reviews was moderate. The majority (55.3%) of the evidence evaluated by GRADE was of low quality, while the remaining outcomes were categorized as having “very low”-quality evidence.ConclusionCurrent evidence links heart disease during pregnancy to adverse maternal outcomes, including death and cardiac, pulmonary, and cerebrovascular events, as well as increased mortality risk for offspring. Many meta-analyses in this field have limitations that raise concerns about their validity, highlighting the need for high-quality prospective studies.

Epidemiological Investigation of Unplanned Intensive Care Unit Admissions From the Operating Room After Elective Surgery: A Nationwide Observational Study in Japan.

Over 75% of surgeries worldwide are elective and unplanned ICU admissions after these surgeries pose a major-albeit rare-challenge. However, few epidemiological studies have focused on patients requiring unplanned ICU admission directly from the operating room after elective surgeries are lacking. This study uses the Japanese Intensive Care Patient Database (JIPAD) to describe unplanned ICU admissions after elective surgeries. We conducted a multicenter retrospective cohort study using data from the JIPAD from April 2015 to March 2022, focusing on patients with unplanned ICU admissions after elective surgery. Collected variables included patient characteristics, treatments, outcomes, reasons for ICU admission, and type of surgery. We categorized the reasons for ICU admission into 9 types: anaphylaxis, hemorrhage, anesthesia-related complications, respiratory-related complications, cardiovascular-related complications, neurological-related complications, surgical-related complications, electrolyte/acid-base abnormalities, and unknown causes. The type of surgery was classified using JIPAD definitions. Among 141,969 patients in the JIPAD who underwent elective surgery, 2666 patients (1.9%) required an unplanned ICU admission. Cardiac arrest before ICU admission occurred in 52 patients (2.0%), the median APACHE III score was 51, and 1218 patients (45.7%) required postoperative mechanical ventilation. The median hospital stay for patients with unplanned ICU admission was 21 days and in-hospital mortality was 3.3% (88/2666). The most common reason for ICU admission was respiratory complications (n = 440, 16.5%), followed by hemorrhage (n = 377, 14.1%). Cardiovascular-related complications had the highest in-hospital mortality at 6.8% (20/294). Hospital mortality exceeded ICU mortality, suggesting that patients expected to derive limited benefit from intensive care may have been transitioned out of the ICU to accommodate other patients with greater need. The most frequent surgeries requiring unplanned ICU admission were for gastrointestinal neoplasms (n = 464, 17.4%), followed by orthopedic surgeries (n = 303, 11.4%). Anaphylaxis occurred across a broad spectrum of surgeries. Respiratory-related complications were common in patients with other respiratory diseases and accounted for over half of the total number of cases according to surgery type. Neurological-related complications were most frequent in craniotomies for neoplasms. In our review of a nationwide ICU database from 2015 to 2022 we identified a 1.9% rate of unplanned ICU admission and found that mortality varied according to the reasons for ICU admission. Respiratory-related complications were most common, and cardiovascular complications were most associated with in-hospital mortality. Further research may help us to better understand the epidemiology of unplanned ICU admission after surgery.

Long-Term Prognostic Power of Three-Dimensional Speckle-Tracking Echocardiography-Derived Peak Left Atrial Reservoir Global Longitudinal Strain in Healthy Adults—An Analysis from the MAGYAR-Healthy Study

Introduction: The contraction–relaxation pattern of the left atrial (LA) walls is opposite to that detected in the left ventricle, which includes thinning in radial, lengthening in longitudinal, and widening in circumferential directions in the systolic reservoir phase of LA function as measured by three-dimensional speckle-tracking echocardiography (3DSTE). Global longitudinal strain (GLS) is a quantitative feature of longitudinal wall contraction referring to the whole LA. The present study aims to clarify the expected prognostic impact of peak LA-GLS as assessed by 3DSTE in healthy participants during a long-term follow-up period. Methods: The study consisted of 142 healthy adults (with an average age of 32.1 ± 12.7 years; 72 of the participants were men), in whom complete two-dimensional Doppler echocardiography and 3DSTE were performed on a voluntary basis. Results: Thirteen adults suffered from a cardiovascular event, including two cardiac deaths during a mean follow-up of 8.35 ± 4.20 years. Peak LA-GLS ≥ 20.9%, as assessed by 3DSTE, was found to be a significant predictor for cardiovascular event-free survival by using ROC analysis (specificity 74%, sensitivity 62%, area under the curve 0.69, p = 0.025). Healthy individuals with peak LA-GLS &lt; 20.9% had a lower LV-EF and a significantly higher ratio of cardiovascular events compared to cases with peak LA-GLS ≥ 20.9%. Subjects who experienced cardiovascular events had lower peak LA-GLS and the ratio of subjects with peak LA-GLS &lt; 20.9% proved to be significantly increased compared to that of cases without cardiovascular events. Conclusions: 3DSTE-derived peak LA-GLS representing LA lengthening in the end-systolic reservoir phase of LA function predicts future cardiovascular events in healthy adults.

A Rare Case of Dual Lad Type 4 in Inferior Myocardial Infarction Patient, a Case Report

Abstract Background This case highlights a type 4 dual left anterior descending coronary artery anomaly, identified incidentally during coronary angiography. Case summary A 51-year-old male patient presented with acute myocardial infarction, which was successfully treated with thrombolysis and percutaneous coronary intervention. Angiography revealed an anomalous origin of the left anterior descending artery from the right coronary artery. Stenting was performed on the right coronary artery and the right posterior descending artery branch. Discussion Type 4 I dual left anterior descending artery is a rare coronary anomaly with potential clinical risks, including sudden cardiac death due to its course between major arteries. Variations in the structure of coronary arteries can present challenges for interventional cardiologists when conducting percutaneous coronary interventions. Accurate coronary anatomy assessment via angiography and computed tomography coronary angiography is crucial for successful percutaneous coronary intervention and surgical planning. Although uncommon, The dual left anterior descending artery type 4 anomaly is a significant coronary artery variation that interventional cardiologists must consider due to its impact on prognosis and long-term treatment strategies.

Prognostic relevance of baseline exercise stress test in RYR2-related CPVT.

Exercise stress test (EST) represents the gold standard for diagnosis of catecholaminergic polymorphic ventricular tachycardia (CPVT). We aimed to determine the relevance of exercise induced VT for the occurrence of LAE at follow-up. In RYR2-related CPVT patients who underwent a baseline EST, we assessed the incidence and severity of ventricular arrhythmias (VA). Data were analysed using logistic regression models and Cox proportional hazards models. The primary outcome was the occurrence of life-threatening arrhythmic event (LAE; composite of sudden cardiac death, aborted cardiac arrest, or hemodynamically non-tolerated VT) at follow-up. In 102 RYR2-related CPVT patients (65 females; median age 16 years, IQR: 11-36 years), exercise-induced VT (bidirectional in 64% of cases) was elicited in 56% patients. VT could not be induced in pre-school children. Lower basal heart rate, early onset VA (within the first step of EST) and heart rate at the first minute of recovery were associated with exercise-induced VT. Cox analyses showed that early onset VA (HR 6.0, 95% CI: 1.3-27.9, P = 0.022) and exercise-induced VT (HR 6.6, 95% CI: 1.5-29.1, P = 0.012) at baseline EST were significantly associated with the occurrence of LAE at follow-up, and remained associated even after correction for symptoms. Early onset VA and exercise-induced VT at baseline EST was associated with LAE at follow-up, allowing to identify a sub-set of patients at higher risk already at diagnosis.

Outcomes of surgical management for Kommerell's diverticulum associated with type b aortic dissection.

Kommerell's diverticulum presents a distinctive challenge in clinical management due to its rarity and diverse clinical manifestations, particularly when concurrent with type B aortic dissection. However, a consensus on the optimal treatment strategy has yet to be established. This study presents our experience with an open surgical approach to treating Kommerell's diverticulum associated with type B aortic dissection. This retrospective study evaluated 10 patients who underwent surgical repair for Kommerell's diverticulum with concurrent type B aortic dissection. Through median sternotomy, under cardiopulmonary bypass and deep hypothermic circulatory arrest + retrograde cerebral perfusion, a frozen elephant trunk stent graft was deployed in the descending thoracic aorta to address the type B aortic dissection and Kommerell's diverticulum. Aberrant subclavian arteries were reconstructed by bypassing the distal portion into the native ascending aorta or carotid artery, accompanied by proximal ligation of the aberrant artery. The median age of patient was 49 years (Interquartile range: 42.2-58.5). There were no in-hospital or 30-day post-operative deaths. All patients were discharged with a median hospital stay of 8.5 days (Interquartile range: 7.75-10.5). No cases of stroke or spinal cord ischaemia were observed. Follow-up was completed for all patients, with a mean duration of 27.4 (Standard deviation: 15.3) months, during which no adverse events occurred. This surgical approach for managing Kommerell's diverticulum with type B aortic dissection offers a safe and effective option, yielding favourable short-term outcomes. It may provide a durable alternative to traditional surgical methods and overcome limitations associated with endovascular surgeries.

Lack of Racial Disparities in Cangrelor Therapy in Patients Presenting With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Cangrelor is an intravenous P2Y12 receptor antagonist that exerts rapid and potent antiplatelet effects. It is associated with a reduction in the indcidence of ischemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The aim of our study was to investigate the racial disparities and their impact on outcomes among patients with ACS who were treated with cangrelor during PCI. We reviewed the data of patients with ACS who were treated with cangrelor during PCI at our center from 2018 to 2023 and divided between African American (AA) and Caucasian patients. The primary safety outcome was in-hospital thrombolysis in myocardial infarction (TIMI) major bleeding. The primary efficacy outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of cardiac death, MI, or stroke. Multivariate regression analysis was performed to assess the primary outcomes after controlling for differences in baseline characteristics. The study included 1181 patients who received cangrelor during PCI for ACS, including 616 AA and 565 Caucasian patients. AA patients were significantly younger (61 ± 13 vs. 64 ± 12 years; p < 0.001) and had higher rates of hypertension, diabetes mellitus, and end-stage renal disease requiring dialysis. There were no significant differences between AA and Caucasian patients regarding in-hospital TIMI major bleeding (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.16-1.88; p = 0.343) and in-hospital MACE (OR: 1.82; 95% CI: 0.71-4.69; p = 0.212) after controlling for relevant baseline differences. No racial disparities were observed with regard to the administration of cangrelor during PCI in patients presenting with ACS, and cangrelor was not associated with increased bleeding for AA patients as compared to Caucasian patients.

Successful rescue of a patient with cardiogenic shock following traumatic cardiac arrest using VA-ECMO after air medical transport: a case report

BackgroundTraumatic cardiac arrest (TCA) poses significant challenges in resuscitation, with extremely high mortality rates, making it a critical issue in emergency and critical care medicine. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a crucial rescue technology for patients with cardiac arrest, providing short-term support for cardiopulmonary failure. However, the successful application and related clinical experience of VA-ECMO in TCA remain limited and require further investigation.Case presentationA male patient sustained a stab wound to the left lower limb, resulting in femoral artery and vein injuries, massive hemorrhage, and subsequent hemorrhagic shock. The patient experienced cardiac arrest upon admission to a local hospital. Following cardiopulmonary resuscitation (CPR) and emergency femoral vascular reconstruction surgery, spontaneous circulation was temporarily restored, but the patient remained hemodynamically unstable postoperatively. Initial treatment at the local hospital was ineffective. On the second morning, the patient was transferred to our hospital via air medical transport, with a transport time of 35 min. Upon arrival, the patient was promptly evaluated, and VA-ECMO support was initiated within 17 min. After 3 days of VA-ECMO support and 5 days of mechanical ventilation, the patient was successfully weaned from life support and discharged in good condition.ConclusionVA-ECMO can significantly improve the survival outcomes of patients with cardiogenic shock following traumatic cardiac arrest. The use of interhospital air medical transport effectively reduces rescue time, providing critical opportunities for the timely management of severely ill patients.

The Heart Team Approach to Cardiac Arrest

Abstract Cardiac arrest is a critical emergency in cardiovascular medicine, requiring rapid, multidisciplinary interventions to enhance patient survival and neurological outcomes. This review explores the unique challenges of managing out-of-hospital and in-hospital cardiac arrest, with a focus on mechanical circulatory support and extracorporeal cardiopulmonary resuscitation for selected patients. While out-of-hospital cardiac arrest management should prioritize rapid transport to specialized centers, in-hospital cardiac arrest may allow for immediate, patient-tailored interventions. Post-cardiac arrest syndrome adds complexity, often requiring nuanced mechanical circulatory support escalation and weaning. Standardized protocols, ethical considerations, and further research are essential to refine patient selection and improve outcomes, ultimately advancing cardiac arrest care.

Impact of geriatric nutritional risk index and diabetes mellitus on prognosis in ischaemic heart failure with reduced ejection fraction

It is unclear whether diabetes mellitus (DM) affects the role of malnutrition in heart failure (HF). We evaluated the effect of the geriatric nutritional risk index (GNRI) on HF prognosis and DM’s role in this relationship. This single-centre retrospective cohort study included 540 HF patients with nutritional data grouped by DM status and GNRI score. The primary endpoint was all-cause mortality. Eighty-four patients (15.6%) were classified as malnourished (GNRI ≤ 98). Over a median follow-up of 4.0 years, 102 patients died. The DM/low GNRI (L-GNRI) group had the highest risk of all-cause death (HRadj: 3.253, 95% CI 1.643–6.474, P < 0.001) and cardiac death (HRadj: 3.411, 95% CI 1.606–7.243, P < 0.001) compared to the non-DM/high GNRI group. The adverse impact of L-GNRI was more pronounced in DM than in non-DM patients (Pinteraction < 0.05). In the total population and DM subgroup, GNRI was independently associated with an increased risk of all-cause and cardiac death after adjustment (all P < 0.05). In patients with DM, the GNRI classification significantly enhanced the predictive value of the model (all P < 0.05). A negative correlation between GNRI and HbA1c was observed only in patients with DM. Patients with HF with DM and malnutrition had the poorest prognosis. Poor glycemic control is related to increased malnutrition risk.

Point-of-Care Ultrasound Diagnosis of Restrictive Cardiomyopathy in a 3-Year-Old Patient.

Restrictive cardiomyopathy is a rare form of cardiomyopathy in children, representing only 2.5%-3% of all pediatric cardiomyopathies, and is typically diagnosed between the ages of 6 and 10. The underlying etiology varies depending on age and region; however, idiopathic, genetic, and endomyocardial fibrosis are among the most common. Cohort studies have demonstrated mortality as high as 50% within 2 years of diagnosis, as well as high rates of adverse events including thromboembolism, pulmonary hypertension, and sudden cardiac death. There is a paucity of literature on point-of-care ultrasound (POCUS) for the diagnosis of pediatric restrictive cardiomyopathy. We present a case of a 3-year-old female whose diagnosis of heart failure was rapidly identified via POCUS which subsequently expedited life-saving treatment.