European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Mar 2017
Resuscitation outcomes of reproductive-age females who experienced out-of-hospital cardiac arrest.
Although some studies have shown that women in their reproductive years have better resuscitation outcomes of out-of-hospital cardiac arrest (OHCA), conflicting results and methodological problems have also been noted. Thus, we evaluated the resuscitation outcomes of OHCA of females by age. ⋯ Women of reproductive age did not show improved resuscitation outcomes in OHCA. Additionally, women in their reproductive years showed worse neurological outcomes one month after the event, which may be explained by the negative effects of estrogen. These findings need to be verified in further studies.
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Eur Heart J Acute Cardiovasc Care · Feb 2017
Short-term mechanical circulatory support with the Impella 5.0 device for cardiogenic shock at La Pitié-Salpêtrière.
Cardiogenic shock carries a high mortality rate despite aggressive medical treatment. The Impella® Recover® LP 5.0 Support System is a microaxial minimally invasive ventricular assist device designed for short-term mechanical circulatory support in low cardiac output states. The aim of this study is to assess the safety of the Impella 5.0 device, using the right axillary artery approach, in cardiogenic shock managed at La Pitié-Salpêtrière Hospital. ⋯ The Impella 5.0 device surgically inserted through the axillary artery is a valuable minimally invasive short-term circulatory support in cardiogenic shock of various aetiologies.
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Eur Heart J Acute Cardiovasc Care · Feb 2017
Gender-specific diagnostic performance of a new high-sensitivity cardiac troponin I assay for detection of acute myocardial infarction.
The determination of cardiac troponin is essential for diagnosing myocardial infarction. A troponin I assay has recently been developed that provides the highest analytical sensitivity to date. ⋯ The investigational troponin I assay provides an excellent non-ST-segment elevation myocardial infarction rule out. With gender-specific differences, the application of absolute changes in troponin concentration was superior to relative changes to rule in patients with non-ST-segment elevation myocardial infarction.
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Eur Heart J Acute Cardiovasc Care · Feb 2017
On versus off-hour care of patients with acute coronary syndrome and persistent ST-segment elevation in certified German chest pain units.
Regional healthcare projects improve the off-hour care of patients with acute coronary syndromes and persistent ST-segment elevation myocardial infarction (STEMI). To analyse differences in quality of care between on and off-hour care of STEMI patients admitted to certified German chest pain units. ⋯ The German chest pain unit network ensures rapid and structured preclinical and in-hospital care independent from the circadian variation of admission. Slower door to balloon times off-hours are compensated by faster symptoms to admission or symptoms to FMC intervals. Further efforts should focus on patient awareness programmes on-hours and STEMI alarming tracks off-hours.
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Eur Heart J Acute Cardiovasc Care · Dec 2016
ReviewExtracorporeal life support for out-of-hospital cardiac arrest: Part of a treatment bundle.
In recent years, an increasing number of papers have been published on the use of extracorporeal cardiopulmonary resuscitation (ECPR) in adult patients, but, although promising results have been reported in patients with in-hospital refractory cardiac arrest supported by extracorporeal life support (ECLS), data on patients with out-of-hospital (OHCA) cardiac arrest are scarce and conflicting. The present study aims at summarizing the available evidence on the use of ECPR in adult patients with OHCA, clinically focusing on the factors most often associated with outcome in these patients. ⋯ According to the available evidence, three factors seem to contribute strongly to the favorable outcome of ECLS supported OHCA patients: (a) selection of patients (mainly definition of age range and a witnessed cardiac arrest); (b) the availability of an ECLS team, well skilled and experienced (to reduce time of implantation and incidence of complications); (c) a multifaceted approach to the OHCA patient (the so-called ECLS-bundle) to treat the reversible cause of CA (i.e. percutaneous coronary intervention), ensure neuroprotection (hypothermia), and maintain organ perfusion (till recovery). Taking into account the promising results of ECPR in selected OHCA patients, there is a clinical need for shared protocols to reduce differences related to the center experience and mostly to increase availability of ECLS as part of a multifaceted approach for these patients.