Extracorporeal Pulmonary Resuscitation (ECPR) of Out-of-Hospital Cardiac Arrest

For decades, extracorporeal life support (commonly referred to as extracorporeal membrane oxygenation, or ECMO) was used in the operating room (OR) and ICU to treat refractory shock, typically after surgery. More recently, ECMO has been used to treat refractory cardiac arrest; in this indication, it takes the name “ECPR.” Today, ECPR is used in many places. Although there are published case reports, series and after/before studies, there have been no randomized controlled trials to illustrate its effectiveness in the resuscitation of out-of-hospital cardiac arrest (OHCA) patients. However, ECPR is now recommended by international guidelines in the management of refractory OHCA of suspected reversible cause, such as acute myocardial infarction, refractory cardiac arrest of suspected reversible cause, pulmonary embolism and intoxication.1 The 2015 American Heart Association Guidelines recommend ECPR could be considered in refractory cardiac arrest of suspected reversible cause.2 ECPR is the second line of treatment for OHCA not responding to usual BLS and ALS treatments (e.g., cardiac compressions/ massage, ventilation, defibrillation, drug administration, etc.). ECPR brings respiratory and circulatory support, ensuring sufficient blood and oxygen supply to the whole body, especially the brain. The ECPR response team in Paris implements ECMO on scene to restore blood flow to the body and limit ischemic consequences to the brain and coronary arteries. The hybrid impl...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Heart of America Source Type: news

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AbstractObjectivesThe OVID study will demonstrate whether prophylactic-dose enoxaparin improves survival and reduces hospitalizations in symptomatic ambulatory patients aged 50 or older diagnosed with COVID-19, a novel viral disease characterized by severe systemic, pulmonary, and vessel inflammation and coagulation activation.Trial designThe OVID study is conducted as a multicentre open-label superiority randomised controlled trial.ParticipantsInclusion Criteria1. Signed patient informed consent after being fully informed about the study ’s background.2. Patients aged 50 years or older with a positive test for SARS-...
Source: Trials - Category: Research Source Type: clinical trials
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is responsible for an unprecedented worldwide pandemic that has severely impacted the United States. As the pandemic continues, a growing body of evidence suggests that infected patients may develop significant coagulopathy with resultant thromboembolic complications including deep vein thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke. However, this data is limited and comes from recent small case series and observational studies on stroke types, mechanisms, and outcomes.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
Covid-19 has significant implications of hematologic systems, including lymphocytopenia, thrombocytopenia, ischemic or hemorrhagic stroke, pulmonary thromboembolism, and myocardial infarction [1,2]. Iwasaki et al. reported that the pathogen of Covid-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can induce immune dysfunction, inflammation, and antibody-dependent enhancement by activating host cells via the Fc γIIa receptor in the same way as SARS-CoV-1 [3].
Source: Thrombosis Research - Category: Hematology Authors: Tags: Letter to the Editors-in-Chief Source Type: research
CONCLUSION: Daratumumab is associated with lower risk of VTE in clinical trials. PMID: 32710431 [PubMed - as supplied by publisher]
Source: International Journal of Hematology - Category: Hematology Authors: Tags: Int J Hematol Source Type: research
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory distress syndrome coronavirus 2. This syndrome generally begins with respiratory symptoms that may progress to single-organ dysfunction (ie, respiratory failure) and then to multiorgan failure and death. In nonpregnant patients admitted to the intensive care unit with COVID-19 pneumonia, the frequency of venous thromboembolic disorders is 25% (20 of 81) detected by ultrasound examination of the lower extremities.1 In another series of 184 patients with confirmed COVID-19 pneumonia, 31% of patients had venous or arterial thromboembolism (defined as ac...
Source: American Journal of Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Letter to the Editors Source Type: research
RARITAN, NJ, March 28, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson today announced the VOYAGER PAD study met its primary efficacy and principal safety endpoints, demonstrating the XARELTO® (rivaroxaban) vascular dose (2.5 mg twice daily) plus aspirin (100 mg once daily) was superior to aspirin alone in reducing the risk of major adverse limb and cardiovascular (CV) events by 15 percent in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization, with similar rates of TIMI[1] major bleeding. VOYAGER PAD is the only study to show a significant benefit...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
PS Abstract BACKGROUND: Isolated PE is associated with a higher burden of atherosclerotic disease than other manifestations of venous thromboembolism (VTE). RESEARCH QUESTION: We hypothesized that the presence of isolated PE may signal a chronically elevated risk of arterial thrombotic disease. STUDY DESIGN AND METHODS: Data from the VTEval Study, a prospective cohort study enrolling individuals with clinical suspicion and imaging-based diagnosis or exclusion of VTE, were analyzed. Patients with PE received whole-leg ultrasonography to assess presence of deep vein thrombosis (DVT). Regularized logistic ...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
ConclusionAmong patients with AF, OSA is an independent risk factor for MACNE and, more specifically, stroke/SE.Graphical Abstract
Source: American Heart Journal - Category: Cardiology Source Type: research
Publication date: Available online 22 November 2019Source: Journal of Cardiology CasesAuthor(s): Elena Vladimirovna Reznik, Ekaterina Sergeevna Shcherbakova, Svetlana Vasilievna Borisovskaya, Yurij Valerevich Gavrilov, Tatyana Mikhailovna Pajeva, Sergey Vladislavovich Lepkov, Aleksej Borisovich Mironkov, Eliso Murmanovna Dzhobava, Igor Gennadievich NikitinAbstractThis clinical case report describes the simultaneous development of an acute myocardial infarction, stroke, and a massive pulmonary thromboembolism in a 44-year-old patient — a carrier of the thrombophilia gene polymorphisms: MTHFR C677T, А1298C, PAI-1 4G/5...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Conclusion: In the literature there are many data on the main causes of death for patients with COPD, such as respiratory failure, lung cancer, pulmonary thromboembolism, but due to the high comorbidity of COPD with cardiovascular pathology, and the mechanism of mutual complications of these nosologies, according to our research, today the main causes of death for patients with COPD are cardiovascular accidents caused by hypercoagulation.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Monitoring airway disease Source Type: research
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