Perspectives on why DanGer Shock is the first positive trial on mechanical circulatory support in cardiogenic shock.

Cardiogenic shock related to acute myocardial infarction (AMI-CS) remains a severe condition associated with a high risk of mortality despite increased availability of primary percutaneous coronary intervention and improvements in pharmacologic and device-based therapy. The results of the DanGer Shock trial stand out compared with the outcomes of the previous trials and mark the first mechanical circulatory support (MCS) strategy to show a benefit in patients with AMI-CS, a population that has always been challenging to study. Notably, negative findings from previous trials may mask positive treatment effects in specific subgroups and patient category.

Tailoring the Best Positive End-Expiratory Pressure Through Invasive Right Ventricular Pressure-Volume Loops in a Patient Supported by Veno-Arterial Extracorporeal Membrane Oxygenation.

Patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) typically suffer from cardiogenic pulmonary edema and lung atelectasis, which can exacerbate right ventricular (RV) dysfunction through an increase in lung elastance and RV afterload. Invasive mechanical ventilation settings, and positive end-expiratory pressure (PEEP) in particular, can help to improve RV performance by optimizing lung recruitment and minimizing alveolar overdistention. In this report, we present a VA-ECMO supported patient in whom in vivo RV pressure-volume (PV) loops were measured during a decremental PEEP trial, leading to the identification of an optimum PEEP level from a cardio-respiratory viewpoint.

Photoplethysmography and intracardiac pressures: early insights from a pilot study.

Aims: Invasive haemodynamic monitoring of heart failure (HF) is used to detect deterioration in an early phase thereby preventing hospitalizations. However, this invasive approach is costly and presently lacks widespread accessibility. Hence, there is a pressing need to identify an alternative non-invasive method that is reliable and more readily available.

Perioperative outcome, long-term mortality and time trends in elderly patients undergoing low-, intermediate- or major non-cardiac surgery.

Background: Decision-making whether older patients benefit from surgery can be a difficult task. This report investigates characteristics and outcomes of a large cohort of inpatients, aged 80 years and over, undergoing non-cardiac surgery.

Methods: This observational study was performed at a tertiary university medical centre in the Netherlands.