The War on Shock: Is Industry Leading the Charge? The War on Shock: Is Industry Leading the Charge?

Protocols for patients in cardiogenic shock encourage use of mechanical circulatory support and play down palliative care, despite limited supporting data, writes interventional cardiologist Jaya on Medscape
Source: Medscape General Surgery Headlines - Category: Surgery Tags: Cardiology Commentary Source Type: news

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Balloon aortic valvuloplasty (BAV) is indicated in patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic stenosis,1 either as palliative therapy for patients who are not candidates for valve replacement,2 or as a bridge to transcatheter (TAVR) or surgical aortic valve replacement (SAVR).1,3 Given the high morbidity and mortality associated with BAV, especially because it is performed not infrequently in critically ill patients, it is important to understand the effect of hospital procedural volume on outcomes following BAV.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
AbstractIntravenous inotropic therapy can be used in patients with advanced heart failure, as palliative therapy or as a bridge to cardiac transplantation or mechanical circulatory support, as well as in cardiogenic shock. Their use is limited to increasing cardiac output in low cardiac output states and reducing ventricular filling pressures to alleviate patient symptoms and improve functional class. Many advanced heart failure patients have sinus tachycardia as a compensatory mechanism to maintain cardiac output. However, excessive sinus tachycardia caused by intravenous inotropes can increase myocardial oxygen consumpti...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
To evaluate the clinical characteristics of patients withdrawn from veno-arterial extracorporeal membrane oxygenation support (VA-ECMO), as well as the role of palliative care (PC) consultation in the decision to withdraw VA-ECMO.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (1056) Source Type: research
Abstract Cardiogenic shock (CS) is a multifactorial disease process with high morbidity and mortality. When it occurs in a peri- or intraoperative setting, factors such as surgery, anesthesia, and post-surgical physiology can negatively affect patient outcomes. Since patient needs often escalate during CS-from medications to mechanical support to palliative care-this disease demands a multidisciplinary approach that encompasses all aspects of medical delivery. Preliminary studies have indicated that a multidisciplinary team approach to CS results in earlier diagnosis and treatment and improves patient outcomes. He...
Source: Methodist DeBakey Cardiovascular Journal - Category: Cardiology Authors: Tags: Methodist Debakey Cardiovasc J Source Type: research
ConclusionPC utilization increased substantially during the 10-years study period in the United States in STEMI-CS. Several baseline, procedural, hospital, and socioeconomic factors were associated with PC referral in the setting STEMI-CS.
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
Abstract OBJECTIVE: Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample. METHOD: This was a pilot prospective, observational...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Tags: Palliat Support Care Source Type: research
Journal of Palliative Medicine, Ahead of Print.
Source: Journal of Palliative Medicine - Category: Palliative Care Authors: Source Type: research
By  SAURABH JHA After Dr. Hadiza Bawa-Garba was convicted for manslaughter for delayed diagnosis of fatal sepsis in Jack Adcock, a six-year-old boy who presented to Leicester Royal Infirmary with diarrhea and vomiting, she was referred to the Medical Practitioners Tribunal (MPT). The General Medical Council (GMC) is the professional regulatory body for physicians. But the MPT determines whether a physician is fit to practice. Though the tribunal is nested within the GMC and therefore within an earshot of its opinions, it is a decision-making body which is theoretically independent of the GMC. The tribunal met in 2017...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: NHS #BawaGarba @roguerad Source Type: blogs
Mortality in cardiogenic shock remains unacceptably high. Early involvement of specialist level palliative care in similar populations show benefit to both patients and caregivers. The purpose of this study is to describe the utilization of PCC and its timing in cardiogenic shock patients requiring short-term mechanical circulatory support (STMCS).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
CONCLUSIONS: The provision of palliative care varied widely by patient and facility characteristics. Palliative care was infrequently used in hospitalized patients with AKI requiring dialysis, despite its poor prognosis and the regular application of life-sustaining therapy. PMID: 29042462 [PubMed - as supplied by publisher]
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
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