Treatment Of Acute Cardiac Failure Research Articles

Nephrology: what's new in 2022

Severe cases of IGA nephropathy might benefit from corticosteroid therapy. Inflimidase may be a promising treatment of Goodpasture disease. SGLT2 inhibitors and acetazolamide act synergistically with loop diuretics in the treatment of acute cardiac failure. In hemodialysis, use of lung ultrasound to determine the ultrafiltration seems to decrease hospitalizations due to acute heart failure but does not reduce patient-centered outcomes. Icodextrin may mitigate the loss of ultrafiltration in PD patients who are carriers of the Aquaporin I promotor TT genotype. MICA-antibodies have an impact on the risk of graft rejection. Xenotransplantation may become a reality.

Treatment of acute cardiac failure in the emergency department. Improve our practices? Data from the RESURCOR network

In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: -use of intravenous vasodilators (nitrates) when systolic blood pressure is>110mmHg; -non-invasive ventilation if oxygen saturation is<90% and/or respiratory rate is>25/min despite nasal oxygen; -using a reduced dose of intravenous furosemide (20-40mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; -early performance of echocardiography. We sought to compare the gap between these recommendations and clinical practices in French emergency departments (EDs). We undertook a retrospective evaluation of clinical practices in 834 consecutive patients with ACF admitted in 2013 to the EDs of 16 French hospitals. Data, including patient characteristics and practices were collected from the medical records. Patients' mean±standard deviation age was 82±10 years and 49% were men. Clinical practices in relation to the guideline recommendations are shown in the Table 1. These initial data which precede publication of the current guidelines, show that use of nitrates, non-invasive ventilation, reduced diuretic dose and early echocardiography were relatively infrequent at the first point of medical care for patients presenting with ACF. These findings indicate the need for a sizable shift in practice in order to meet the new guideline recommendations. We will conduct a repeat evaluation in 2016, after implementation of a programme aimed to improve practices at these sites.

0448: Treatment of acute cardiac failure in the emergency department. Improve our practices? Data from the RESURCOR network

Admission of patients with acute cardiac failure (ACF) is common in emergency departments (EDs), but taking care of them is challenging. Based on a retrospective evaluation of clinical practices in a network of 16 hospitals in the French Alps, we developed a programme of improvements. We report preliminary data from the first evaluation of this programme. We undertook a retrospective evaluation of clinical practices in ACF patients admitted to the ED in 2013 (phase 1). In 2015, following a review of these practices, we implement a set of recommendations, which were evaluated in 2016 (phase 2). The study population comprised patients admitted to the ED with an admission diagnosis of ACF. Data, including patient characteristics and practices, were collected retrospectively from the medical records. We report preliminary data from 155 patients included in phase 1 of this evaluation. Patients’ mean±SD age was 84.3±7.9 years and 63 (41%) were men. Among 38 patients with oxygen saturation <90% or breath rate >30/min despite nasal oxygen, 9 (24%) underwent non-invasive ventilation. Thirty-three (25%) of 133 patients with systolic arterial pressure >110mmHg were treated with nitroglycerine. One patient was treated with morphine. Sixteen patients (10%) underwent echocardiography in the ED. By September 2015, phase 1 data from 1000 patients will be collected from the 16 hospitals, analysed and will be presented at the meeting. These initial data show that nitroglycerine, morphine, noninvasive ventilation, and echocardiography seem not commonly used at the first point of medical care for patients presenting with ACF.

Combining ECMO with IABP for the Treatment of Critically Ill Adult Heart Failure Patients

To discuss the experience of combining extra-corporeal membrane oxygenation (ECMO) with intra-aortic balloon pump (IABP) for the treatment of acute heart failure in critically ill adults. The clinical data of 54 patients who received ECMO combined with IABP due to acute heart failure between January 2008 and July 2012 were retrospectively analysed. Thirty-eight of the patients were male, and 16 were female; the mean age was 57±11. Thirty-nine of the patients received IABP first but were still unable to maintain adequate circulation, and were then given ECMO; the other 15 underwent ECMO first, but due to increased left ventricular load, the opening of the aortic valve was restricted and IABP was then introduced. Thirty-four patients (63%) were successfully weaned from ECMO; 21 patients (38.9%) survived to discharge. Major complications that occurred were renal failure (27 cases), infection (20 cases), blood plasma leakage in the oxygenator (13 cases), bleeding (18 cases), limb ischaemia (eight cases), and neurological complications (seven cases); in the group of patients who did not survive, the rates of bleeding occurrence, infection and renal failure were markedly higher than in the survived patients group. In both groups, the longer the patients were on support, the more improvement they showed in terms of MAP, CVP, Lac, SvO2 and IS. ECMO and IABP may have synergistic effects and play complementary roles in the treatment of acute cardiac failure; with timely administration, active prevention and treatment of complications, they can improve treatment outcome.

Pushing the Envelope: “Awake Venoarterial Extracorporeal Membrane Oxygenation” in Pediatric Patients with Acute Cardiac Failure

Objectives: In pediatric patients with cardiogenic shock (CS)/or acute cardiac failure (ACF) extracorporeal membrane oxygenation (ECMO) is often used as a bridging procedure to recovery or further implantation of a ventricular assist device (VAD). Although ECMO has been established as a routine procedure in pediatric tertiary care centers, the clinical path guiding these patients to fully recovery or further VAD implantation is one of the most challenging for pediatric intensivists. Methods: The authors describe the use of venoarterial ECMO (VA-ECMO) as a treatment strategy for ACF in spontaneously breathing and conscious pediatric patients. It presents their experiences with the first five children treated using this new concept. The mean age of the patients was 86 months (range 0 – 226 mo). Mean amount of time on ECMO was 35 days (range 7 – 94 d). Results: Three patients fully recovered with their cardiac function while being treated on “Awake-VA-ECMO,” one was bridged to LVAD and one was successfully bridged to transplantation. Four of the five patients are alive without any recurrences. One patient died before a further heart transplantation while being on intracardiac rotation pump. Although reintubation was necessary in three of our five patients (due to interventional heart catheter) total time breathing spontaneously and being conscious while on ECMO was > 70%. Conclusion: The authors conclude that the concept of “Awake VA-ECMO” is feasible and safe for the treatment of ACF and can be used as a “bridging therapy” to recovery or further VAD implantation in pediatric patients.

Decision making for mechanical cardiac assist in pediatric cardiac surgery

The practice of pediatric cardiac surgery has evolved to the point where the majority of patients operated on represent the most complex end of the spectrum of congenital heart disease. Given this, the potential role for mechanical cardiac assist will continue to expand. Although extracorporeal membrane oxygenation remains the mainstay of mechanical circulatory assist, the increased use of centrifugal ventricular assist devices is changing the approach to the treatment of acute cardiac failure. A range of newly developed implantable and paracorporeal devices is beginning to make its way into the clinical practice of pediatric cardiac surgery. This article addresses the different types of support available for mechanical cardiac assist and the clinical considerations in selecting the appropriate device.

Hemodynamic effects of ECG-triggered muscular counterpulsation in controls and patients with coronary artery disease

Objectives: ECG-triggered peripheral muscular counterpulsation (MCP) was proposed as a new non-invasive technique for treatment of acute cardiac failure in coronary artery disease (CAD). Study purpose: 1) to evaluate safety and efficiency of MCP; 2) to determine its hemodynamic effect on cardiac function.

Hämodynamische Effekte verschiedener Dosierungen des Phosphodiesterase-III-Hemmers R80122

Selective inhibitors of the phosphodiesterase isoenzyme III (PDE-III) are well known for the treatment of catecholamine-resistent acute cardiac failure because of their inotropic, lusitropic, and vasodilative properties. The aim of this clincial study was to investigate the hemodynamic effects of increasing doses of the PDE-III-inhibitor R80122 in order to determine the optimal dosage of R80122 for the treatment of acute cardiogenic failure.¶ Thirty male patients with coronary artery disease were investigated prior to coronary artery bypass grafting. They were randomly assigned to one of the five following groups: a control group not receiving R80122 and 4 groups receiving an incremental bolus dose of R80122 from 0.1mg/kg to 0.4mg/kg bodyweight. Hemodynamic measurements were performed before and 5, 10, 15, 30, 45, and 60 minutes after i.v. injection of R80122.¶ A dosage of 0.2mg/kg to 0.4mg/kg R80122 induced a significant increase in cardiac index immediately after administration which then continued during the entire measurement period. This increase in cardiac index was accompanied by an increase in heart rate at dosages of 0.3mg/kg and 0.4mg/kg R80122. Only after 0.3mg/kg R80122 an increase in stroke volume index was found 10 minutes after drug administration. A concomitant decrease in mean arterial pressure was observed in the first 15 minutes after drug application at dosages of 0.2mg/kg to 0.4mg/kg R80122. This was mainly caused by a dose-dependent decrease in systemic vascular resistance index. A maximal decrease in systemic vascular resistance index was found during the first 15 minutes after administration of the PDE-III-inhibitor.¶ The results of our study demonstrate that R80122 significantly increases cardiac index in patients with coronary artery disease. Increasing doses of R80122, however, elicit the risk of undesireable hemodynamic effects. Therefore, an initial dosage of 0.2mg/kg R80122 seems to be adequate for the treatment of acute cardiac failure because of a minimal increase in heart rate und decrease of mean arterial pressure.

Acute haemodynamic effects of dopexamine in patients with coronary arterial disease

We assessed the acute haemodynamic effects of dopexamine 1 μg/kg/min and 3 μg/kg/min in 21 patients with coronary arterial disease following routine catheterisation. Patients were aged 38 to 72 years and left ventricular ejection fraction ranged from 23 to 79%. Dopexamine was well tolerated in all patients except one in whom transient ventricular arrhythmias occurred with 3 μg/kg/min. No patient developed angina. Dopexamine increased cardiac index (2.6 ± 0.4 to 3.2 ± 0.1 ( P < 0.001) and 4.0 ± 1.0 l/min/m 2 ( P < 0.001), control to 1 μg/kg/min and 3 μg/kg/min, respectively) and decreased systemic vascular resistance index (3356 ± 1506 to 2318 ± 809 ( P < 0.001) and 2252 ± 1973 dyne · sec · cm −5/m 2 ( P < 0.001)), but did not affect systemic arterial, pulmonary arterial or right atrial pressure. Maximum positive dP dt was increased (1294 ± 324 to 1597 ± 505 ( P < 0.001) and 2199 ± 819 mmHg/sec ( P < 0.001)) as was left ventricular stroke work index (44 ± 20 to 51 ± 21 ( P < 0.05) and 56 ± 27 g · m/m 2 ( P < 0.001) control to 1 μg/kg/min and 3 μg/kg/min, respectively). Left ventricular end diastolic pressure fell with 3 μg/kg/min from 19.8 ± 6.9 to 12.4 ± 4.6 mmHg ( P < 0.05) in patients with preserved left ventricular ejection fraction (> 50%, n = 6), but not in those with impaired left ventricular ejection fraction (< 50%, n = 15), otherwise the effects in these two subgroups were similar. We conclude that dopexamine has both inotropic and vasodilator properties. Despite increasing left ventricular stroke work index and contractility it is well tolerated by patients with ischaemic heart disease, and would therefore be useful in the treatment of acute cardiac failure in this group of patients.

The Use of Strophanthin or Strophanthus in Treatment of Acute Cardiac Failure

The Use of Strophanthin or Strophanthus in Treatment of Acute Cardiac Failure

Symptoms and Treatment of Acute Cardiac Failure; Report of a Case

Symptoms and Treatment of Acute Cardiac Failure; Report of a Case