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.

Impacto de la movilización en pacientes portadores de soporte circulatorio mecánico de corta duración tipo Levitronix® CentriMag como puente a trasplante cardíaco / Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation

Introducción: Pese a los beneficios de la movilización en el paciente crítico, la evidencia de su aplicación en pacientes portadores de Levitronix® CentriMag como puente a trasplante cardíaco (TC) es prácticamente nula. El objetivo del estudio fue analizar el impacto de la movilidad en estos pacientes. Métodos: Estudio observacional retrospectivo. Se incluyeron los pacientes sometidos a un TC previamente portadores de Levitronix® CentriMag ingresados entre el 2010 y el 2019 en el Hospital Universitario de Bellvitge. Se relacionaron las variables grado de movilidad y estado nutricional con la evolución clínica posterior al TC (infecciones, tiempo de estancia en UCI y mortalidad). Resultados: Los 27 pacientes seleccionados se dividieron en dos grupos según el grado de movilidad (22 baja y 5 alta). Se observó una supervivencia a 90 días post-TC del 63,6% en el grupo de pacientes con movilidad baja, mientras que en el grupo con movilidad alta fue del 80%; no se observaron diferencias estadísticamente significativas. Tampoco las hubo en la distribución de las altas de UCI desde el TC a 30 días. Por otro lado, se observaron unos menores niveles de albúmina en el grupo de movilidad baja, con una diferencia estadísticamente significativa (24,5 g/L [RIC: 23-30] vs. 33 g/L [RIC: 26-36]; p = 0,029). También se observaron diferencias en la mediana de días de ventilación mecánica invasiva (VMI) post-TC (p = 0,014), siendo mayor en el grupo de movilidad baja. No se observaron diferencias en la aparición de infecciones ni UPP. Conclusiones: Los pacientes con un grado de movilidad alto presentaron un menor tiempo de VMI y un mejor estado nutricional. No se observaron complicaciones asociadas a la movilidad. No se encontraron diferencias significativas entre el grado de movilidad y la mortalidad a 90 días, el tiempo de ingreso en UCI, la aparición de infecciones o UPP post-TC.(AU)

Introduction: Despite the benefits of mobilization in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is almost absent. 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 “Hospital Universitario de Bellvitge” (Barcelona). 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 = 0.029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = 0.014). 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.(AU)

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.

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

Objetivo El objetivo del estudio fue analizar la supervivencia al alta hospitalaria de los pacientes tras la instauración de una membrana de oxigenación extracorpórea veno-arterial (ECMO-VA) durante paro cardiorrespiratorio (simultáneamente o durante las 6 horas posteriores a este) en un hospital de tercer nivel español. Metodología Estudio descriptivo y retrospectivo de los pacientes sometidos a una terapia ECMO-VA durante o tras maniobras de reanimación cardiopulmonar (ERCP) en los últimos 10 años. Las variables fueron extraídas de la historia clínica electrónica de cada paciente. Resultados Se implantaron 175 ECMO, el 84% (147) fueron ECMO-VA y el 17% (25) su indicación fue de ECPR. El 40% (10) la terapia ECMO se inició simultáneamente durante las maniobras de RCP y el resto (15) en las 6 horas posteriores. Se obtuvieron tasas de supervivencia del 44%. Conclusiones El uso de la ERCP a pacientes bien seleccionados puede mejorar su supervivencia. (AU)

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. (AU)

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

Actualmente, el control estricto de temperatura mediante hipotermia inducida (entre 32 y 36 oC) se considera un tratamiento de primera línea en el manejo de pacientes con parada cardiaca recuperada que ingresan en Unidades de Cuidados Intensivos. Su objetivo es disminuir el daño neurológico secundario a anoxia cerebral. Aunque existen múltiples evidencias sobre sus beneficios, el empleo de esta técnica en nuestro país es pobre y todavía existen temas controvertidos como temperatura óptima, velocidad de instauración, duración y proceso de calentamiento. El objetivo de este trabajo es desarrollar la evidencia científica actual y las recomendaciones de las principales guías internacionales. El enfoque de este documento se centra también en aplicación práctica del control estricto de la temperatura en la parada cardiaca recuperada en nuestras Unidades de Cuidados Intensivos Generales o Cardiológicas, principalmente en los métodos de aplicación, protocolos, manejo de las complicaciones y elaboración del pronóstico neurológico. (AU)

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. (AU)

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.