The Impella CP device for acute mechanical circulatory support in refractory cardiac arrest.

INTRODUCTION: Mechanical circulatory support may be considered as a therapeutic option in selected patients with refractory cardiac arrest (rCA). Animal studies suggest a potential role for the Impella® left ventricular assist device in this setting, but so far no human data have been published. METHODS: Eight patients with rCA were treated with the Impella CP® device at our institution from November 2014 to October 2015. The Impella CP® was used at the discretion of the treating physicians in patients with rCA and pulseless electrical activity with presumed primary left ventricular failure. These patients were compared to 12 patients with cardiogenic shock also treated with the Impella device during the same period. RESULTS: All cardiac arrests were witnessed with a no-flow time of 0min, six in-hospital and two out-of-hospital. Low-flow time was 50±52min (SD). The Impella device was successfully inserted in all patients with rCA and circulation was re-established. Survival rate to hospital discharge with good neurological outcome was similar among patients with rCA and cardiogenic shock treated with the Impella device (50% vs. 58%). Major vascular complications after Impella insertion occurred more frequently among patients with rCA compared to patients with cardiogenic shock (50% vs. 0%, P<0.05). CONCLUSION: Mechanical support with the Impella CP® device is a feasible and promising treatment option for selected patients with rCA. Further studies are warranted to determine the full potential and optimal patient selection compared to other modalities of mechanical circulatory support.

[Extracorporeal membrane oxygenation treatment for a patient with life-threatening asthma].

This is a case report of a young male with life-threatening asthma presenting hypercapnia and respiratory acidosis despite mechanical ventilation and intense broncholytic medication. He was treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) through a double-lumen catheter placed in the right jugular vein. This patient, as well as two other comparable patients, improved respiratory and circulatory within 3 h of VV-ECMO treatment. Smaller low-flow ECMO devices for CO2 removal are emerging but attention should be kept on the fact, that they are not capable of oxygenation.

[Lung sonography in the critically ill patient]. / Ultralydsskanning af lungerne hos den kritisk syge patient.

Lung sonography is an old technique applied in a new fashion. Applying lung sonography in the examination of an acute patient with pulmonary problems is a novelty in Denmark. Applications, limitations, techniques, equipment and general principles for lung sonography are reviewed. We introduce the "typical signs" such as lung sliding and artefacts. The rationale for lung ultrasonography in the treatment of acute patients seems obvious when comparing this technique with conventional diagnostic tools for the diagnosis of pulmonary status.

[Double cardiac arrest caused by amniotic fluid embolism during caesarean section]. / Dobbelt hjertestop ved amnionvaeskeemboli opstået under kejsersnit.

Amniotic fluid embolism is a rare unpredictable complication of pregnancy with high maternal morbidity and mortality rates because of the risk of cardio-respiratory collapse and/or disseminated intravascular coagulation (DIC). We here report a case of a patient who survived without any sequelae after two cardiac arrests and subsequent DIC due to amniotic fluid embolism during a caesarean section. Early consideration of the diagnosis after prompt resuscitation is needed to reduce morbidity and mortality.