Construction and Evaluation of a Realistic Low-Cost Model for Training in Chest-Tube Insertion.

INTRODUCTION: Emergency thoracostomy is applied in life-threatening situations. Simulation plays a pivotal role in training in invasive techniques used mainly in stressful situations. Currently available commercial simulation models for thoracostomy have various drawbacks. METHODS: We designed a thoracostomy phantom from discarded hospital materials and pigskin with underlying flesh. The phantom can be used alone for developing technical skills or mounted on an actor in simulation scenarios. Medical students, intensive care unit (ICU) and emergency department teams, and thoracostomy experts evaluated its technical fidelity and usefulness for achieving learning objectives in workshops. RESULTS: The materials used to construct the phantom cost €47. A total of 12 experts in chest-tube placement and 73 workshop participants (12 ICU physicians and nurses, 20 emergency physicians and nurses, and 41 fourth-year medical students) evaluated the model. All groups rated the model's usefulness and the sensation of perforating the pleura highly. Experts rated the air release after pleura perforation lower than other groups. Lung reexpansion was the lowest rated item in all groups. Ratings of the appearance and feel of the model correlated strongly among all groups and experts. The ICU professionals rated the resistance encountered in introducing the chest drain lower than the other groups. CONCLUSIONS: This low-cost, reusable, transportable, and highly realistic model is an attractive alternative to commercial models for training in chest-tube insertion skills.

Seguridad y resultados del implante de MitraClip en insuficiencia mitral funcional según el grado de disfunción ventricular izquierda / Safety and outcomes of MitraClip implantation in functional mitral regurgitation according to degree of left ventricular dysfunction

INTRODUCCIÓN Y OBJETIVOS: Recientemente se han presentado 2 estudios aleatorizados con resultados confrontados sobre la reparación percutánea de la válvula mitral con dispositivo MitraClip en pacientes con insuficiencia mitral funcional (IMF). El objetivo del presente estudio es evaluar la seguridad y el impacto en el pronóstico del tratamiento de la IMF con MitraClip en función del estado del ventrículo izquierdo (VI). MÉTODOS: Se realizó un cribado retrospectivo de los pacientes con IMF tratada con MitraClip en nuestro centro, dividiéndolos en 2 grupos según la fracción de eyección del VI (FEVI) y el diámetro telediastólico del VI: «VI extremo» (FEVI ≤ 20% y/o diámetro telediastólico del VI ≥ 70 mm) y «VI no extremo» (FEVI> 20% y diámetro telediastólico del VI <70 mm). Se realizó un análisis de supervivencia por eventos cardiovasculares que incluía ingreso hospitalario por insuficiencia cardiaca, trasplante cardiaco o muerte cardiovascular. Asimismo se compararon la clase funcional y el número de ingresos por insuficiencia cardiaca durante los años previo y posterior al implante del dispositivo. RESULTADOS: Se incluyó a 58 pacientes con IMF consecutivos (28 con VI extremo y 30 con VI no extremo). El seguimiento medio fue de 19,5±13 meses. Los pacientes con VI no extremo mostraron una supervivencia libre de eventos cardiovasculares significativamente mayor (log-rank, 3,706; p = 0,010). Al año de la intervención, ambos grupos mostraron una mejoría de los síntomas. La mayoría de los pacientes se encontraban entonces en clase funcional I-II de la New York Heart Asssociation (el 100% del grupo de VI no extremo y el 84% del grupo de VI extremo) y se observó una reducción del número de ingresos hospitalarios por insuficiencia cardiaca en ambos grupos. CONCLUSIONES: El implante del dispositivo MitraClip parece ser seguro y efectivo en la reducción de la IMF. Pese a que los pacientes con FEVI muy baja y/o VI muy dilatado parecen tener un peor pronóstico cardiovascular, la intervención en ellos fue segura y mejoró sus síntomas

INTRODUCTION AND OBJECTIVES: Recent randomized trials of the MitraClip system have reported controversial results in the treatment of patients with functional mitral regurgitation (FMR). The aim of the present study was to evaluate the safety and impact of MitraClip implantation on outcomes in FMR according to left ventricular (LV) status. METHODS: Patients with FMR undergoing MitraClip implantation in our center were retrospectively screened and divided into 2 groups according to LV ejection fraction (LVEF) and LV end-diastolic dimension: "very poor LV" (LVEF ≤ 20% and/or LV end-diastolic dimension ≥ 70 mm) and "poor LV" (LVEF> 20% and LV end-diastolic dimension <70 mm). Survival analysis of cardiovascular outcomes included hospital admission due to congestive heart failure, heart transplant, and cardiovascular death. Likewise, we compared the number of hospital admissions and functional class the year before and after the intervention. RESULTS: Fifty-eight consecutive patients with FMR were included (28 with very poor LV and 30 with poor LV). The mean follow-up was 19.5± 13 months. Patients with poor LV showed a significantly better event-free survival for cardiovascular events (log-rank 3.706, P=.010). One year after the intervention, both groups showed symptom improvement. Most of the patients were in New York Heart Association functional class I-II (100% poor LV and 84% very poor LV) and both groups showed a decrease in the number of hospital admissions due to congestive heart failure. CONCLUSIONS: MitraClip implantation seems to be safe and effective in reducing FMR. Although patients with very low LVEF and/or very enlarged LV seemed to have worse cardiovascular outcomes, the intervention was safe and resulted in symptom improvement

Safety and outcomes of MitraClip implantation in functional mitral regurgitation according to degree of left ventricular dysfunction.

INTRODUCTION AND OBJECTIVES: Recent randomized trials of the MitraClip system have reported controversial results in the treatment of patients with functional mitral regurgitation (FMR). The aim of the present study was to evaluate the safety and impact of MitraClip implantation on outcomes in FMR according to left ventricular (LV) status. METHODS: Patients with FMR undergoing MitraClip implantation in our center were retrospectively screened and divided into 2 groups according to LV ejection fraction (LVEF) and LV end-diastolic dimension: "very poor LV" (LVEF ≤ 20% and/or LV end-diastolic dimension ≥ 70 mm) and "poor LV" (LVEF> 20% and LV end-diastolic dimension <70 mm). Survival analysis of cardiovascular outcomes included hospital admission due to congestive heart failure, heart transplant, and cardiovascular death. Likewise, we compared the number of hospital admissions and functional class the year before and after the intervention. RESULTS: Fifty-eight consecutive patients with FMR were included (28 with very poor LV and 30 with poor LV). The mean follow-up was 19.5± 13 months. Patients with poor LV showed a significantly better event-free survival for cardiovascular events (log-rank 3.706, P=.010). One year after the intervention, both groups showed symptom improvement. Most of the patients were in New York Heart Association functional class I-II (100% poor LV and 84% very poor LV) and both groups showed a decrease in the number of hospital admissions due to congestive heart failure. CONCLUSIONS: MitraClip implantation seems to be safe and effective in reducing FMR. Although patients with very low LVEF and/or very enlarged LV seemed to have worse cardiovascular outcomes, the intervention was safe and resulted in symptom improvement.