Heart, lung & circulation
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Heart, lung & circulation · Mar 2018
Review Meta AnalysisAntiarrhythmics in Cardiac Arrest: A Systematic Review and Meta-Analysis.
It is widely accepted that antiarrhythmics play a role in cardiopulmonary resuscitation (CPR) universally, but the absolute benefit of antiarrhythmic use and the drug of choice in advanced life support remains controversial. ⋯ This systematic review and meta-analysis suggests that, based on current literature and data, there has been no conclusive evidence that any antiarrhythmic agents improve rates of ROSC, survival to admission, survival to discharge or neurological outcomes. Given the side effects of some of these agents, we recommend further research into their utility in current cardiopulmonary resuscitation guidelines.
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Heart, lung & circulation · Mar 2018
ReviewLeft Heart Disease and Pulmonary Hypertension: Are We Seeing the Full Picture?
Pulmonary hypertension (PH) is common, under diagnosed and associated with a high mortality. There are significant delays in the diagnosis of pulmonary hypertension leading to increased morbidity and delays in the initiation of treatment. ⋯ Regardless of the underlying pathophysiology of LHD, the sequelae lead to pressure overload on the left heart and a reactive increase in pulmonary pressures. In this review article, we will discuss the prevalence of PH, examine the pathophysiology of PH-LHD, establish how echo can be used to identify patients with PH-LHD and discuss surrogate echo markers of PVR.
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Heart, lung & circulation · Mar 2018
ReviewEfficacy and Safety of Inter-Atrial Shunt Devices for Heart Failure With Reduced or Preserved Ejection Fraction: Early Experiences.
Elevated left atrial (LA) pressure is thought to be the common final pathological way in decompensated heart failure (HF). We aimed to gather currently available clinical evidence to evaluate the feasibility of inter-atrial shunt devices in HF patients. ⋯ Current evidence suggests that inter-atrial shunting might be a potential and promising therapy for HF, regardless of the ejection fraction.
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Heart, lung & circulation · Feb 2018
Review Meta AnalysisTranscatheter Aortic Valve Implantation in Intermediate Surgical Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis.
Recent data from randomised and observational studies have reported non-inferior outcomes for transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in intermediate-risk patients. We performed a systematic review to evaluate the mortality of TAVI compared to SAVR in intermediate-risk patients. ⋯ In the intermediate-risk patients, the 30-day and 12-month mortality are similar between TAVI and SAVR. Increased operator experience and improved device technology have led to a significant reduction in mortality in intermediate-risk patients undergoing TAVI.
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Heart, lung & circulation · Jan 2018
Observational StudyLactate and Echocardiography Before Veno-Venous Extracorporeal Membrane Oxygenation Support.
Lactate has been recognised as a prognostic factor in several critical conditions. Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is a well-established therapy in patients with Acute Respiratory Disease Syndrome (ARDS) unresponsive to conventional therapy and echocardiography pre ECMO initiation has been recently reported to help in risk stratifying these patients. ⋯ In refractory ARDS, hyperlactataemia before VVV-ECMO identified a subset of patients at higher risk of death, being an independent predictor of in-Intensive Care Unit (ICU) mortality. Lactate values are mainly related to disease severity (as indicated by SAPS II) and haemodynamic impairment (as inferred by LVEF) and RV failure, as (indicated by TAPSE).