Cardiogenic Shock Intravascular Cooling Trial (CHILL-SHOCK).

BACKGROUND: Cardiogenic shock (CS) is complicated by high mortality rates. Targeted temperature control (TTC) has been proposed as an adjunct therapy in CS. This study aims to examine the safety of TTC in patients presenting with CS. METHODS AND RESULTS: In this open-label, randomized controlled pilot trial, 20 patients with hemodynamic criteria for CS were assigned to standard of care plus TTC vs standard of care alone. The primary outcome was a composite safety outcome, including well-described complications of TTC. Secondary outcomes included mortality at 90 days, invasive hemodynamic and echocardiographic parameters, electrocardiographic measurements, and inotrope dosing. There were no significant differences in the composite analysis of prespecified safety outcomes (3 events in the TTC group vs 0 events in the control group; P = 0.24). Patients randomized to TTC demonstrated a statistically significant increase in cardiac index and cardiac power index compared to the control group at 48-96 hours after randomization (3.6 [3.1, 3.9] L/min/m2 vs 2.6 [2.5, 3.15] L/min/m2; P = 0.029 and 0.61 [0.55, 0.7] W/m2 vs 0.53 [0.435, 0.565] W/m2; P = 0.029, respectively). CONCLUSION: TTC may be a safe adjunct therapy for patients presenting with CS and may yield improvement in specific hemodynamic parameters.

Long-Term Outcomes of Patients With Pulmonary Embolism Managed With Endovascular Therapies Compared to Medical Therapy.

Background: Guidelines on the management of acute pulmonary embolism (PE) recommend consideration of endovascular therapies (EVT) for patients at intermediate-high risk. However, long-term data on the outcomes of patients after EVT as compared to medical therapy is lacking. This study aimed to compare outcomes of patients receiving EVT as compared to medical therapy alone at 3 to 6 months. Methods: In this single-center, retrospective cohort study, 190 patients with PE underwent evaluation for presence of right ventricular (RV) dysfunction by transthoracic echocardiogram, residual perfusion defects on ventilation-perfusion scanning, and functional capacity by 6-minute walk distance (6MWD) at 3 to 6 month follow-up. Results: Fifty-eight (31%) patients received EVT for the management of their acute PE. At follow-up (median 120 [97-170] days), 71% of patients who received EVT had normalization of RV function compared with only 34% of patients who received medical therapy alone (P < .001). Patients who received EVT had a significantly greater increase in their estimated glomerular filtration rate (P = .001), decrease in N-terminal proB-type natriuretic peptide (P = .003), and decrease in hemoglobin values (P = .018). Patients with intermediate-high to high risk PE who received EVT had significantly greater distance achieved on their 6MWD as compared to those who received medical therapy alone (P = .025). Conclusions: Patients with acute PE who received EVT plus medical therapy were more likely to achieve normalization of RV dysfunction at 3 to 6 month follow-up compared to patients who received medical therapy alone. These data suggest that EVT is an effective therapy option for acute PE in intermediate-high and high risk patients with potential durable long-term benefits.

The influence of target distance on perceptual self-motion thresholds and the vestibulo-ocular reflex during interaural translation.

An elegant and influential mathematical model of eye movements is the geometric compensation required for visual fixation location in the translational vestibulo-ocular reflex (VOR). Compensatory eye velocity scales with the inverse of fixation distance during head translation because larger angular eye movements are required to minimize retinal slip during head translation when targets are closer. This model has been extensively verified in experiments. Since the VOR and vestibular perception have shared anatomic pathways, we asked whether the same scaling may affect motion perception. Since perception does not require the linear-to-angular transformation required for the translational VOR, we hypothesized that perception would not scale with target distance. Subjects were tested with a motion direction-recognition threshold task in which they reported their perception of small translations of their body. Thresholds were measured in three conditions: (1) with a near target (0.20m) that extinguished just before each motion; (2) with a far target (0.47m); 3) with no target. The subject was always in darkness during motion. Thresholds were 0.59, 0.61 and 0.61cm/s, respectively. Translational VOR sensitivity (eye angular velocity divided by head translation velocity) was also measured and modulated with target distance. The scaling ratio of responses for the near vs. far target was 0.97 for perceptual thresholds, which was significantly different from the compensatory ratio (2.35; P<0.001) and the translational VOR scaling ratio (1.59; P=0.007) but not from no compensation (1.00; P=0.93). Thus, we conclude that despite shared anatomy for the VOR and perception, the brain processes signals according to the geometric functional constraints of each task.