Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest.

BACKGROUND: Recent data identifies extracorporeal cardio-pulmonary resuscitation (eCPR) as a potential addendum of conventional cardiopulmonary-resuscitation (cCPR) in highly specified circumstances and selected patients. However, consented criteria indicating eCPR are lacking. Therefore we provide first insights into the health-related quality of life (HRQoL) outcomes of patients treated with eCPR in a real world setting. METHODS: Retrospective single-center experience of 60 consecutive patients treated with eCPR between 01/2014 and 06/2016 providing 1-year survival- and HRQoL data obtained through the Short-Form 36 Survey (SF-36) after refractory out-of-hospital- (OHCA) and in-hospital cardiac arrest (IHCA) of presumed cardiac etiology. RESULTS: Resuscitation efforts until initiation of eCPR averaged 66 ±â€¯35 min and 63.3% of the patients suffered from OHCA. Fifty-five (91.7%) of the overall events were witnessed and bystander-CPR was performed in 73.3% (n = 44) of cases. Cause of arrest was dominated by acute myocardial infarction (AMI, 66.7%) and initial rhythm slightly outbalanced by ventricular fibrillation/tachycardia (VF/VT 53.3%). 12-month survival was 31%. Survivors experienced more often bystander-CPR (p = .001) and a shorter duration of cCPR (p = .002). While mid-term survivors' perceived HRQoL was compromised compared to controls (p ≦ .0001 for PF, RP, RE and BP; p = .007 for GH; p = .016 for SF; p = .030 for MH; p = .108 for VT), scores however resembled HRQoL of subjects on hemodialysis, following cardiogenic shock or pulmonary failure treated with extracorporeal membrane oxygenation (ECMO). CONCLUSIONS: While HRQoL scores of our survivors ranged markedly below controls, compared to patients on chronic hemodialysis, following ECMO for cardiogenic shock or pulmonary failure most of the discrepancies ameliorated. Thus, successfull eCPR in properly selected patients does translate into an encouraging HRQoL approximating chronic renal failure.

Treating resistant hypertension with new devices.

Arterial hypertension is a frequent, chronic disease, which is one of the main risk factor for cardiovascular and renal diseases such as heart failure, chronic kidney disease, hypertensive heart disease, stroke as well as cardiac arrhythmias. In the clinical setting it remains challenging to accomplish the thresholds of guideline blood pressure (BP) levels now defined as office based BP to be below <140 mmHg. Patients on three or more antihypertensive drugs, with systolic BP values above ≥160 mmHg (≥150 mmHg for patients with type 2 diabetes) are classified as having resistant hypertension. In the past six years the development of interventional sympathetic renal artery denervation (RDN) opened a new treatment option targeting the afferent and efferent sympathetic nerves of the kidney to reduce BP. A large variety of devices are available on the market. Newly developed devices try to focus on new strategies such as ultrasound or irrigated catheters, which might reduce the post-procedural complications and increase the success rate. The first generation SymplicityTM device (Medtronic, Palo Alto, CA, USA) was shown to be safe, with side effects rarely occurring. Clinical trials demonstrate that this procedure is successful in about 70% of patients. However current data from Simplicity HTN-3 with 25% african-americans and a massive BP-lowering effect in the control "sham" group was not able to find a significant effect in the overall patient cohort. Possibly devices which allow to safely destroy sympathetic renal innervation more efficiently might allow for a higher responder rate. Irrigated RDN and ultrasound devices could deliver more energy to deeper tissue levels. This article provides an overview of currently available data on devices.

[Interventional left atrial appendage occlusion : alternative to oral anticoagulation for stroke prevention in atrial fibrillation]. / Interventioneller Vorhofohrverschluss : Alternative zur Antikoagulation in der Schlaganfallprophylaxe bei Vorhofflimmern.

Stroke prevention in patients with atrial fibrillation is one of the greatest challenges in modern cardiology. Interventional left atrial appendage occlusion is an alternative to oral anticoagulation in patients with non-valvular atrial fibrillation. This procedure is currently used mainly for patients with elevated risk for bleeding complications (HAS-BLED score ≥3) or other contraindications for oral anticoagulation. The novel anticoagulants dabigatran, rivaroxaban and apixaban carry a risk for major bleeding for 2-3% of patients per year. The indications for an interventional left atrial appendage closure are therefore not affected by these substances. Several devices have been developed for this purpose; however, currently only the WATCHMAN® and AMPLATZER® cardiac plug are used in the clinical routine in Germany. The WATCHMAN® device proved to be non-inferior to oral anticoagulation with warfarin in the PROTECT-AF trial in terms of safety and efficacy. These findings are supported by data from registries with up to 5 years follow-up. For the second device currently used in clinical practice, the AMPLATZER® cardiac plug, there is increasing data from registries suggesting comparable safety and efficacy. Both devices necessitate anticoagulation during the first 3-6 months after implantation until endothelialization is completed. Due to the anatomical complexity the implantation should be performed in experienced centers with reduction of the periprocedural risk to <1%. Thus, interventional left atrial appendage occlusion is a valid option to prevent stroke or other thromboembolic events in non-valvular atrial fibrillation especially for elderly patients or those with a history of bleeding complications.