Echocardiographic Prediction of Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation.

BACKGROUND: Weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) support fails in 30% to 70% of patients. OBJECTIVE: To explore the utility of echocardiographic parameters in predicting successful disconnection from VA-ECMO. METHODS: Patients receiving VA-ECMO in a referral hospital were included. The relationships between echocardiographic parameters during the weaning trial and weaning success (survival > 24 hours after VA-ECMO explant and no death from cardiogenic shock, heart failure, or cardiac arrest during the hospital stay) and survival were evaluated. RESULTS: Of 85 patients included, 61% had successful weaning. Parameters significantly related to weaning success were higher left ventricular ejection fraction (LVEF; 40% in patients with weaning success vs 30% in patients with weaning failure, P = .01), left ventricular outflow tract velocity time integral (15 cm vs 11 cm, P = .01), aortic valve opening in every cycle (98% vs 91% of patients, P = .01), and normal qualitative right ventricular function (60% vs 42% of patients, P = .02). The LVEF remained as an independent predictor of weaning success (hazard ratio, 0.938; 95% CI, 0.888-0.991; P = .02). An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning (area under the curve, 0.808; sensitivity, 93%; specificity, 72%) and was related to higher survival at discharge (60% vs 20%, P < .001). CONCLUSION: Among weaning trial echocardiographic parameters, LVEF was the only independent predictor of successful VA-ECMO weaning. An LVEF >33.4% was the optimal cutoff value to discriminate patients with successful weaning and was related to final survival.

Short-term mechanical circulatory support in elderly patients.

BACKGROUND: Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short-term MCS. METHODS: Retrospective analysis of ≥70-year-old patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group. RESULTS: Out of 164 short-term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70-year-old patients (73.3% VA-ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high-risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow-up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log-rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post-implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high-risk PCI had higher survival compared to other indications (p = 0.013). CONCLUSION: Short-term MCS with VA-ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high-risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.

Levosimendan in veno-arterial extracorporeal membrane oxygenator supported patients: Impact on the success of weaning and survival.

Weaning failure and mortality rates in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supported patients are significant. Small studies suggest the possible usefulness of levosimendan in this environment, especially in postcardiotomy shock. We performed a retrospective analysis of VA-ECMO implants in a referral hospital comparing weaning failure and survival of patients treated with levosimendan with a control group. From 2013 to May 2020, 123 VA-ECMO for several indications were implanted. Levosimendan was administered in 23 patients (18.7%) with good tolerance. Levosimendan was used more frequently in cardiogenic shock due to acute coronary syndrome indication, and in patients with lower left ventricular ejection fraction (LVEF) at the implant. No significant differences were found in success of ECMO weaning (60.9% levosimendan group vs. 44% non-levosimendan group, P = .169) despite worse LVEF in levosimendan group. Survival at follow-up (20.6 [58] months) was higher in the group that received levosimendan, although without finding statistically significant differences (47.8% vs. 32.0%, log rank P = .124). Levosimendan can be safely administered during VA-ECMO support. Patients receiving levosimendan were weaned similarly from circulatory support despite worse LVEF. Its use did not influence in short- and medium-term survival. Randomized studies are needed to evaluate the levosimendan impact in this indication.

Dispositivos de asistencia ventricular izquierda de larga duración en centros no trasplantadores en España: experiencia inicial / Durable left ventricular assist device therapy in non transplant centers in Spain: initial experience

No disponible

Prevalencia y estacionalidad de la Pediculosis capitis en la población infanto-juvenil de la región sanitaria, Buenos Aires, Argentina / Prevalence and seasonal variation of Pediculosis capitis in the population under sixteen year of age of the health region of Buenos Aires, Argentina

Se estudió la prevalencia de la Pediculosis capitis como enfermedad parasitaria durante el año calendario 1-8-1992 al 31-7-1993, en la Región Sanitaria XI de la provincia de Buenos Aires, Argentina, que comprende 15 partidos del Este Noreste de la provincia de Buenos Aires y otras zonas de influencia del Hospital Interzonal de Agudos, Especialidad Pediatría "Sor María Ludovica", cabecera de dicha Región Sanitaria. Se examinaron un total de 552 individuos de nivel social medio a medio bajo de la población infanto-juvenil de 0 a 16 años, tomados al azar en 52 muestreos semanales consecutivos, considerándose como positivos para esta enfermedad a aquellos parasitados al momento del diagnóstico. Los resultados se expresan en términos de prevalencia analizándose su variación mensual y estacional. La prevalencia fue relativamente alta en todos los meses, con valores mínimos en febrero (12 por cento) y máximos en agosto (56,8 por cento), siendo la media anual de 38, 04 por cento (+/- 4,05). Estacionalmente, su menor valor corresponde al Verano (16,8 por cento), siendo muy semejantes los valores para las restantes estaciones, manteniéndose siempre superiores al 38 por cento