Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation.

INTRODUCTION: Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS: Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS: 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS: Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.

Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital.

GOAL: The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD: This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (CPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS: 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was CPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS: The use of CPR in well-selected patients can improve their survival.

Discharge survival of patients undergoing ECMO therapy after ECPR in a third level hospital. / Supervivencia al alta hospitalaria de los pacientes sometidos a terapia ECMO tras PCR en un hospital de tercer nivel.

GOAL: The goal of this study was to assess the survival to hospital discharge in patients after the implementation of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) during cardiopulmonary arrest (simultaneously or during the first six hours after the event) in a Spanish tertiary hospital. METHOD: This is a descriptive and retrospective study conducted with patients subjected to VA-ECMO therapy during or after cardiopulmonary resuscitation (ECPR) in the last 10 years. The variables were extracted from the electronic medical record of each patient. RESULTS: 175 ECMO therapies were implemented, 84% (147) were VA-ECMO, and the indication for 17% (25) was ECPR. In 40% (10), ECMO therapy was initiated simultaneously during CPR, and the rest (15) during the first six hours after the event. Survival rates reached 44%. CONCLUSIONS: The use of CPR in well-selected patients can improve their survival.

Management of temperature control in post-cardiac arrest care: an expert report. / Manejo con control de temperatura en los cuidados posparada cardiaca: documento de expertos.

Targeted temperature management (TTM) through induced hypothermia (between 32-36 oC) is currently regarded as a first-line treatment during the management of post-cardiac arrest patients admitted to the Intensive Care Unit (ICU). The aim of TTM is to afford neuroprotection and reduce secondary neurological damage caused by anoxia. Despite the large body of evidence on its benefits, the TTM is still little used in Spain. There are controversial issues referred to its implementation, such as the optimal target body temperature, timing, duration and the rewarming process. The present study reviews the best available scientific evidence and the current recommendations contained in the international guidelines. In addition, the study focuses on the practical implementation of TTM in post-cardiac arrest patients in general and cardiological ICUs, with a discussion of the implementation strategies, protocols, management of complications and assessment of the neurological prognosis.

Donor-transmitted malaria after heart transplant managed successfully with artesunate.

Donor-transmitted malaria is a rare complication in solid organ transplantation, which causes high mortality. Data concerning the use of artesunate in solid organ transplant recipients are lacking. We report a heart transplant patient who developed donor-derived severe Plasmodium falciparum malaria, successfully treated with artesunate. Transmission of malaria to 2 of the other transplant recipients from the same donor was also documented.