Weaning failure and mortality rates in veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) supported patients are significant. Small studies suggest the possible usefulness of levosimendan in ...this environment, especially in postcardiotomy shock. We performed a retrospective analysis of VA‐ECMO implants in a referral hospital comparing weaning failure and survival of patients treated with levosimendan with a control group. From 2013 to May 2020, 123 VA‐ECMO for several indications were implanted. Levosimendan was administered in 23 patients (18.7%) with good tolerance. Levosimendan was used more frequently in cardiogenic shock due to acute coronary syndrome indication, and in patients with lower left ventricular ejection fraction (LVEF) at the implant. No significant differences were found in success of ECMO weaning (60.9% levosimendan group vs. 44% non‐levosimendan group, P = .169) despite worse LVEF in levosimendan group. Survival at follow‐up (20.6 58 months) was higher in the group that received levosimendan, although without finding statistically significant differences (47.8% vs. 32.0%, log rank P = .124). Levosimendan can be safely administered during VA‐ECMO support. Patients receiving levosimendan were weaned similarly from circulatory support despite worse LVEF. Its use did not influence in short‐ and medium‐term survival. Randomized studies are needed to evaluate the levosimendan impact in this indication.
Retrospective analysis of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) implants in a referral hospital comparing weaning failure and survival of patients treated with levosimendan with a control group.
Levosimendan can be safely administered during the VA‐ECMO support, allowing a similar weaning success despite worse left ventricular ejection fraction. Its use did not significantly influence in short and medium term survival.
Background
Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess ...the impact of age on survival of patients with short‐term MCS.
Methods
Retrospective analysis of ≥70‐year‐old patients supported with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group.
Results
Out of 164 short‐term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70‐year‐old patients (73.3% VA‐ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high‐risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow‐up (median 13.6 30 months) were similar in elderly and young patients (35.6% vs. 37.8%, log‐rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post‐implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high‐risk PCI had higher survival compared to other indications (p = 0.013).
Conclusion
Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.
Retrospective analysis of ≥70 year old patients under short‐term mechanical circulatory support (MCS): veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® in a referral hospital (elderly group), compared with younger patients (<70 years). Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.
Minor aphthae associated with SARS‐CoV‐2 infection Dominguez‐Santas, Miguel; Diaz‐Guimaraens, Borja; Fernandez‐Nieto, Diego ...
International Journal of Dermatology,
August 2020, Volume:
59, Issue:
8
Journal Article
Advanced chronic kidney disease (A-CKD) combined with atrial fibrillation increases the risk of both thrombogenic and bleeding events. Left atrial appendage occlusion (LAAO) may be an alternative to ...oral anticoagulation to prevent thromboembolic events. We aimed to evaluate the outcomes of LAAO in patients with A-CKD.
Comparison at long-term follow-up of patients diagnosed with and without A-CKD (eGFR<30 mL/min/1.73 m
) who underwent LAAO between 2009 and May 2022.
Five hundred seventy-three patients were included. Eighty-one (14%) were diagnosed with A-CKD. There were no differences in sex, age, and cardiovascular risk factors, except for diabetes which was more frequent in patients with A-CKD. The control group had higher rates of stroke, both ischemic and hemorrhagic. There were no differences in the CHA
DS
-VASc score, although A-CKD patients had a higher bleeding risk according to the HASBLED scale. Global procedural success was 99.1%. At follow-up, there were no differences in stroke rate: at 1-year (HR: 1.22, IC-95%: 0.14-10.42, p = 0.861); at 5-years (HR: 0.60, IC-95%: 0.08-4.58, p = 0.594). Although bleeding events were higher in the A-CKD group, no differences were found in major bleeding (defined BARC ≥ 3) at 1-year (HR: 1.34, IC-95%: 0.63-2.88, p = 0.464) or at 5-years follow-up (HR: 1.30, IC-95%: 0.69-2.48, p = 0.434). Mortality rate at 5 years was higher in the A-CKD patients (HR: 1.84, IC-95%: 1.18-2.87, p = 0.012).
LAAO is an effective and safe treatment in A-CKD patients to prevent ischemic events and bleeding. This strategy could be an alternative to oral anticoagulation in this high-risk group of patients.
In the first wave of COVID-19, up to 20% of patients had skin lesions with variable characteristics. There is no clear evidence of the involvement of the SARS-CoV-2 virus in all cases; some of these ...lesions may be secondary to drug hypersensitivity. To analyze the possible cause of the skin lesions, we performed a complete allergology study on 11 patients. One year after recovery from COVID-19, we performed a lymphocyte transformation test (LTT) and Th1/Th2 cytokine secretion assays for PBMCs. We included five nonallergic patients treated with the same drugs without lesions. Except for one patient who had an immediate reaction to azithromycin, all patients had a positive LTT result for at least one of the drugs tested (azithromycin, clavulanic acid, hydroxychloroquine, lopinavir, and ritonavir). None of the nonallergic patients had a positive LTT result. We found mixed Th1/Th2 cytokine secretion (IL-4, IL-5, IL-13, and IFN-γ) in patients with skin lesions corresponding to mixed drug hypersensitivity type IVa and IVb. In all cases, we identified a candidate drug as the culprit for skin lesions during SARS-CoV-2 infection, although only three patients had a positive drug challenge. Therefore, it would be reasonable to recommend avoiding the drug in question in all cases.
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