James Lundeen, Sr, MS, MD, CIME’s Post

This study explores the efficacy of a novel ECMELLA setup combining veno-arterial extracorporeal membrane oxygenation (va-ECMO) with a micro-axial flow pump in treating cardiogenic shock (CS). Analyzing data from 67 patients treated between December 2020 and December 2022, the study found the technique feasible and effective, with a 27% myocardial recovery rate and a 24% transition rate to #CardiogenicShock #ECLS #ECMELLA #Impella #VAECMO

This study explores the efficacy of a novel ECMELLA setup combining veno-arterial extracorporeal membrane oxygenation (va-ECMO) with a micro-axial flow pump in treating cardiogenic shock (CS). Analyzing data from 67 patients treated between December 2020 and December 2022, the study found the technique feasible and effective, with a 27% myocardial recovery rate and a 24% transition rate to #CardiogenicShock #ECLS #ECMELLA #Impella #VAECMO

ECMELLA or ECMO+Impella is a very effective technique to achieve systemic perfusion AND LV offloading for myocardial recovery. This is increasingly used in post-cardiotomy patients, ECPR/STEMI patients with excellent outcomes. #ECMO #IMPELLA #ECPR #Shock #cardiacarrest #criticalcare

Ahead of print Plasma N-terminal pro-brain natriuretic peptide concentrations may help to identify patients with very low-risk acute pulmonary embolism: A preliminary study Background. Patients with an acute pulmonary embolism (APE) are a heterogeneous group, and some of them may benefit from early discharge and an ambulatory care referral. We aimed to evaluate the use of N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma level assessment in patients with low-risk APE based on clinical findings (0 points on the simplified Pulmonary Embolism Severity Index (sPESI)). Materials and methods. Preliminary analysis of an ongoing prospective study including 1,151 normotensive patients with at least a segmental APE. In the final analysis, 348 patients with a 0-point sPESI were included. Blood samples were collected within the first 24 h of admission. The clinical endpoint (CE) included APE-related mortality and/or rescue thrombolysis in patients with clinical deterioration. https://lnkd.in/dfbzWVhd

Transplant renal artery thrombosis is a rare complication with a prevalence ranging from 0.5-3.5%. Usually, it is a consequence of a technical error during the anastomosis although other causes may be related to both the donor and recipient’s artery condition (i.e. atherosclerosis), intimal rupture during kidney harvesting, acute rejection episodes, external compression by haematoma or lymphocele, hypercoagulative state, severe hypotension, and toxicity of immunosuppressive agents (cyclosporine or sirolimus). The clinical manifestations are acute reduction of urine output and the elevation of renal function tests, often resulting in graft loss. The diagnosis is obtained with eco-colour-Doppler. Surgical exploration is usually recommended to evaluate the status of the graft. Unfortunately, in the majority of the situations, the graft is not perfused and therefore an allograft nephrectomy must be performed. #KidneyTransplant #EAUguidelines Recommendations are posted daily on 'X' and weekly on LinkedIn. For more recommendations visit our website: https://lnkd.in/dRpyAst8

💡Potential Impact of Direct Versus Indirect Central Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Cannulation in Refractory Postcardiotomy Cardiogenic Shock. "The study included 60 patients, 25 received icECMO and 35 treated with dcECMO due to RPCS. The icECMO group demonstrated significantly better 30-day survival rates (icECMO; 10 [40%] vs. dcECMO; 5 [14.3%], log-rank test; p=0.042)..." 📝: Al Ghareeb W, Aldabbas M, Sheikh Ali A, et al. (September 14, 2024) Potential Impact of Direct Versus Indirect Central Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Cannulation in Refractory Postcardiotomy Cardiogenic Shock. Cureus 16(9): e69415. doi:10.7759/cureus.69415 https://lnkd.in/eKW8nr22

#Ang-2 correlated positively with BNP, cTnI, sCr, E/e′, and the extracellular water (ECW)/intracellular water (ICW) ratio (ECW/ICW). After 24 months, a deterioration in renal function was observed in 47 patients (58%). In multivariate regression analysis, both VCAM-1 and Ang-2 showed independent influences on risk of renal replacement therapy initiation. In a Kaplan-Meier analysis, 72% of patients with Ang-2 concentrations below the median (3.15 ng/mL) survived without dialysis for two years. Such an impact was not observed for GFR, VCAM, CCP, VEGF-C, or BTP. Endothelial activation, quantified by plasma levels of Ang-2, may play a key role in GFR decline and the need for dialysis initiation in patients with CKD 3b, 4, and 5. https://lnkd.in/dR-DBsRC

❓ What’s the best vascular access for haemodialysis patients? Thus far, arteriovenous fistulas (AVF) have been the primary choice among experts. (1,2) Central-venous catheters (CVC) come next in line as a secondary option, due to the risk of complications. ❗ Recent findings, however, have challenged this approach: In 2023, Navarro et al. published a study comparing the inflammatory profiles of patients with native AVFs and CVCs. (3) Patients with CVCs used either heparin or TauroLock™-HEP500 as a lock solution.  The results after a period of 3 months: ➡️ No significant changes of inflammatory markers with AVF   ➡️ Significant increase of inflammatory markers with CVC + heparin  ➡️ Significant decrease of inflammatory markers with CVC + TauroLock™-HEP500 Eventually, the inflammatory profile of patients with CVCs using TauroLock™-HEP500 did not differ from that of patients with native AVFs. (3) This discovery is of particular importance considering the correlation between inflammation and biofilm. (4,5) 💡 If TauroLock™-HEP500 can reliably prevent both – might CVCs locked with this product work just as well as AVFs? #taurolock #tauropharm #dialysis #infectionprevention #antimicrobial 1) Schmidli et al. Eur J Vasc Endovasc Surg 2018. DOI: 10.1016/j.ejvs.2018.02.001  2) Lok et al. Am J Kidney Dis 2020. DOI: 10.1053/j.ajkd.2019.12.001   3) Navarro et al. Nephrol Dial Transplant 2023. DOI: 10.1093/ndt/gfad063b_3195  4) Cappelli et al. Nephrol Dial Transplant 2005. DOI: 10.1093/ndt/gfh571  5) Fontseré et al. Antimicrob Agents Chemother 2014. DOI: 10.1128/AAC.02421-14 

🚨 New Insights into Atherosclerotic Plaques in Type 2 Diabetes We’re excited to share our latest article, which uncovers a novel explanation for the formation of dangerous atherosclerotic plaques in individuals with type 2 diabetes. Our findings emphasize the critical role of transforming growth factor-ß2-driven fibrous repair in the progression of these plaques, highlighting it as a potential focus for future therapeutic strategies. 📖 Read the full article: https://lnkd.in/ds2tmAQH #DiabetesResearch #CardiovascularHealth #Atherosclerosis #LUDC #LundUniversity

Epoetin alfa reduces transfusion dependence and improves hemoglobin in low-risk #MDS patients, especially those with lower baseline EPO levels, a new study finds. #hematology Cureus Journal of Medical Science Read more here: https://lnkd.in/eHS5Szk4