Outcomes From Long-Distance Interfacility Transport of Adult Patients on Acute Mechanical Circulatory Support.

Cardiac and respiratory failure in adults has historically had very high mortality. Mechanical circulatory support (MCS) has shown promise to improve outcomes for these patients; however, only tertiary care centers typically have the critical care resources to manage patients on MCS. We investigated to see if we could provide safe, long-distance transport of MCS-supported patients to our tertiary center after MCS is initiated at community or regional hospitals. We also investigated if we could provide this service without using physicians or perfusionists for the en route management of MCS devices. Our outcome results, based on survival to discharge, are comparable with other published survival outcomes data for this patient population, suggesting that patients on MCS devices can be safely transported by air and ground without incurring additional mortality risk. Additionally, instead of perfusionists or physicians, specially trained nurses were used to manage all MCS devices en route. This change to the typical transport team structure has the potential to make the transport of MCS-supported patients more cost-effective for health care systems nationwide.

Polyclonal Immunotactoid Glomerulopathy Associated with Monoclonal Gammopathy of IgM Type and Underlying Plasmacellular Disease: Successful Treatment with Rituximab Alone.

Immunotactoid glomerulopathy (ITG) occurs infrequently and is characterized by organized IgG containing deposits. It most usually manifests as a concomitant disease of a broad spectrum of oncologic entities. We here present an exceptional case of ITG without glomerular light chain restriction secondary to a IgM kappa type monoclonal gammopathy of undetermined significance. Due to nephrotic syndrome and deterioration of kidney function a rituximab monotherapy was initiated without targeting the plasmacellular augmentation, which was confirmed as the underlying process. The treatment led to a long-term improvement of proteinuria and stabilization of glomerular filtration rate. Its therapeutic effect has to be attributed to immunomodulatory capacities and targeting of podocytes rather than to be interpreted as directed against a bone marrow or glomerular clone. We conclude that rituximab therapy may be a valuable part of the therapeutic options in ITG irrespective of the underlying oncologic entity.