Heart : official journal of the British Cardiac Society
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Randomized Controlled Trial
Effect of erythropoietin as an adjunct to primary percutaneous coronary intervention: a randomised controlled clinical trial.
The acute administration of high-dose erythropoietin (EPO) on reperfusing ischaemic myocardium has been reported to halve myocardial infarct (MI) size in preclinical studies, but its effect in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) remains unknown. We investigated whether high-dose EPO administered as an adjunct to PPCI reduces MI size. ⋯ High-dose EPO administered as an adjunct to PPCI failed to reduce MI size. In fact, EPO treatment was associated with an increased incidence of microvascular obstruction, LV dilatation and increased LV mass. Clinical Trial Registration Information http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=4058 Unique Identifier=Study ID 4058.
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Review Meta Analysis
Do antioxidant vitamins have an anti-arrhythmic effect following cardiac surgery? A meta-analysis of randomised controlled trials.
Postoperative atrial fibrillation (POAF) affects approximately 30% of patients undergoing elective cardiac surgery. While its pathogenesis is multifactorial, increasing evidence supports a role for oxidative stress in the electrophysiological remodelling associated with AF. Although prophylactic antioxidants appear to be a potentially attractive pharmacotherapy, there is still uncertainty regarding their efficacy. This study aims to provide a quantitative summary of the current evidence surrounding antioxidant vitamins and POAF prevention. ⋯ The prophylactic use of vitamins C and E may significantly reduce the incidence of POAF and all-cause arrhythmia following cardiac surgery. However, the overall quality of current studies is poor and further research should focus on adequately powered randomised controlled trials that standardise AF reporting, antioxidant protocol and the use of concomitant agents. Cost analysis should be considered to establish the potential economic benefit of antioxidant vitamin prophylaxis in POAF.
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Review
Extracorporeal membrane oxygenation for severe acute respiratory failure in adults: NICE guidance.
Extracorporeal membrane oxygenation (ECMO) is a modified form of cardiopulmonary bypass that allows short-term support for potentially reversible severe acute respiratory and/or cardiac failure in critically ill adults and children. There is increasing interest in veno-venous (VV) ECMO for severe acute respiratory failure in adults. The National Institute for Health and Clinical Excellence has recently updated its interventional procedure guidance, which summarises available data on efficacy and safety of this procedure and provides guidance for clinicians wishing to undertake VV ECMO. The authors summarise and reflect on the guidelines and discuss some recent developments in technology and clinical practice of VV ECMO.
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Multicenter Study
Non-cardiac surgery in patients with coronary stents: the RECO study.
Interruption or maintenance of oral antiplatelet therapy (OAT) during an invasive procedure may result in ischaemic and/or haemorrhagic complications. There is currently a lack of clear guidance regarding the issue of treatment interruption during surgical procedures. ⋯ NCT01045850.