Charles-Henri DAVID’s Post

Mechanical circulatory support in patients with cardiogenic shock, EVACS retrospective multicenter study investigating outcomes of concomitant VA #ECLS + left ventricular unloading with #Impella vs #ECLS alone: 🔍 438 patients included, 2011-2021, from 4 University hospitals (🇫🇷 🇯🇵🇹🇷) 🔍 ECMO alone 72.8%, ECPELLA 27.2%: similar early and mid-term (1-year) survival and incidences of complications ECMO & ECPELLA seems effective strategies in patients requiring temporary #MCS for cardiogenic shock. Exploratory subanalyses suggest that simultaneous implantation of ECMO & Impella might shorten the recovery time, with reduced ICU & hospital LoS. On ASAIO Journal 🖇️ https://bit.ly/4dDWaH5

TL;DR: A study out of Erasmus on ECMO patients found that aPTT alone is as good as aPTT+antiXA+RTE. A (small 250 patient) single-site study out of Erasmus retrospectively compared complications in ECMO patients on heparin when using aPTT (2004-2013) vs. a multimodal protocol (aPPT, antiXa, and rotational thromboelastometry) (2013-), and found that thrombosis and bleeding rates were unchanged after the change in protocol to multimodal. This is particularly salient considering that other hospital practice improvements may have occured in the decade between the cohorts. As a reference for discussing the high risks in ECMO, thrombosis rates were 12-14%, and bleed rates were 36-40%! https://bit.ly/3V2UOwN | #Heparin #ECMO #PrecisionDosing Diman Taha

Interesting new study from ESC 2024! The POPular PAUSE TAVI trial revealed that interrupting oral anticoagulation (OAC) before TAVI reduced bleeding risk, without raising the risk of thromboembolic events like stroke or myocardial infarction. This reinforces that stopping OAC may be a safer approach for TAVI patients. From my experience, this confirms what was already being done at our sites, but it’s great to see this validated in a randomized trial. Of course, patient care is never one-size-fits-all, and individual considerations are always key. #Cardiology #TAVI #ESC2024 #Anticoagulation #ClinicalPractice #PatientSafety #Thrombosis #AtrialFibrillation #BleedingRisk

Summer break is over 🏖️ - yesterday, we held our Impella workshop here at Cellitinnen-Krankenhaus St. Vinzenz. Together with 5 participants from local hospitals nearby, the faculty with Jürgen Leick, Jan Dr. med. Pulz, and Prof. Dr. Jan-Malte Sinning discussed when left ventricular unloading is beneficial for our patients - now also IIbC redommendation in the 2024 #ESC guidelines for #ChronicCoronarySyndrome for #HFrEF patients undergoing #ComplexPCI. We discussed about vascular access and closure, peri- and post-procedural anti-coagulation, and management on ICU. In a #ProtectedPCI live case, we were able to show how the #Impella Smart Assist facilitates extensive lesion preparation in a HFrEF patient (EF<30%) with last remaining vessel situation. After #IVUS guided blade angioplasty of the ostial LAD with #CuttingBalloon, we were able to use a provisional 1-stent-strategy with a #MEGATRON stent and #FinalKissingBalloon inflation over 60 sec with a drug coated balloon #DCB - a maneuver that would never have been possible without hemodynamic protection.

Exciting news from Cardionomic Inc., a Cleveland Clinic portfolio company. Cardionomic has completed its pilot studies evaluating the safety and performance of the Cardiac Pulmonary Nerve Stimulation (CPNS™) System for Acute Decompensated Heart Failure (ADHF) patients. The preliminary results suggest that CPNS therapy may address the unmet need for more effective treatment options for hospitalized heart failure patients. The company treated 35 patients in seven countries, and the data from both studies will be published in early 2024. “This is a significant milestone for Cardionomic, and more importantly for patients suffering from acute decompensated heart failure. The preliminary results from the STIM-ADHF and STOP-ADHF studies suggest that CPNS therapy may address the large unmet need for alternative, and more effective, treatment options for patients hospitalized for heart failure,” said Steve Goedeke, President and Chief Executive Officer of Cardionomic, Inc. We look forward to sharing more information about these studies! https://hubs.li/Q02g3SfP0 #innovation #clevelandclinic #ClevelandClinicInnovations #healthcare #healthcareinnovation

🎉 Thrilled to Announce! 🎉 Our latest article titled "Correlation between Cardiac Output and Disease Severity in Intubated COVID-19 Patients: Insights from Ultrasonic Cardiac Output Monitoring in Intensive Care Unit Settings" has been published! This study delves into the critical relationship between cardiac output (CO) and disease severity in intubated COVID-19 patients, providing valuable insights for ICU settings. 🩺 Major Findings: Continuous hemodynamic monitoring using ultrasonic cardiac output monitoring (USCOM) is crucial for managing intubated COVID-19 patients. Significant changes were observed in cardiac output, SOFA, and APACHE II scores over time. A negative correlation between CO and both SOFA and APACHE II scores was identified, indicating that higher cardiac output is associated with lower disease severity. 🚑 Clinical Implications: This research underscores the importance of integrating USCOM with established scoring systems (APACHE II and SOFA) to dynamically assess and manage the clinical state of COVID-19 patients in the ICU. Enhanced monitoring can contribute to better patient outcomes by providing timely and accurate assessments. 🙏 I am deeply grateful to Prof. Seyed MohammadReza Hashemian for his exceptional supervision and support throughout this study. His guidance has been pivotal in achieving these significant findings. #Research #COVID19 #ICU #CardiacOutput #USCOM #CriticalCare #MedicalResearch #HealthcareInnovation

🌟 Awake ECMO: A Lifesaving Innovation 🌟 At the forefront of critical care, Awake ECMO is revolutionizing the treatment for patients with severe cardiac and pulmonary failure. This innovative approach allows patients to remain awake, breathe on their own, and actively participate in rehabilitation—all while being supported by the ECMO machine. ✅ Improved respiratory muscle tone ✅ Lower risk of ventilator-associated pneumonia ✅ Enhanced physical rehabilitation and communication ✅ Better overall outcomes, including for those awaiting transplants Yashoda Hospitals is proud to be one of the few centers with extensive experience in Awake ECMO, leading to some of the best patient outcomes worldwide. Learn more about how Awake ECMO is changing lives at Yashoda Hospitals: https://lnkd.in/gMK9PA_Q #AwakeECMO #CriticalCare #Cardiology #Pulmonology #PatientCare #HealthcareInnovation #YashodaHospitals #ECMO #TransplantCare

DCB in large coronary arteries

“This study demonstrates that IMT (Inspiratory Muscle Training) initiated on the day of extubation and continued 5 days significantly improves the functional parameters of the diaphragm. We have concluded that IMT applied after extubation may serve as a tool to prevent and facilitate the recovery of diaphragmatic function. Our study results highlight the need for more effective post-extubation care protocols, and suggest that IMT should be considered as a respiratory ICU clinical routine intervention to support the post-extubation process in mechanically ventilated patients.” (Benli et al., 2024) Benli RK, Yurdalan U, Yılmaz B, Adıgüzel N. Effect of post-extubation inspiratory muscle training on diaphragmatic function in mechanically ventilated patients: A randomized controlled trial [published online as ahead of print on January 17, 2024]. Adv Clin Exp Med. 2024. doi:10.17219/acem/174815 #tracheostomy #ventweaning #respiratorymuscletraining #research