Publications by authors named "Belohlavek J"

Background: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support.

Methods: These guidelines are based on clinical practice consensus recommendations and scientific statements.

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  • * It found that using interventions like a closed three-way stopcock or clave significantly prevented air entry, while small volumes of air (1 mL) could still cause dysfunction at certain pump speeds.
  • * Auditory cues, such as a hissing sound, were identified as important early warnings for detecting air presence in the circuit, contributing to the overall safety of ECMO systems and reducing the risk of air embolism.
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Background: Circulatory support with a catheter-based microaxial flow pump (mAFP) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS) and who are not eligible for heart transplantation, durable left ventricular assist device (dLVAD) implantation is usually considered a reliable option. This study aimed to describe the outcome of dLVAD therapy following mAFP support and to identify predictors of mortality.

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Cardiogenic shock (CS) is a devastating and fatal complication of acute myocardial infarction (AMI). CS can affect the pharmacokinetics and pharmacodynamics of medications. The unique properties of cangrelor make it the optimal P2Y12 inhibitor for CS-AMI, in terms of both efficacy and safety.

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Background: The initial rhythm is a known predictor of survival in extracorporeal cardiopulmonary resuscitation (ECPR) patients. However, the effect of the rhythm at hospital admission on outcomes in these patients is less clear.

Methods: This observational, single-center study assessed the influence of the rhythm at hospital admission on 30-day survival and neurological outcomes at discharge in patients who underwent ECPR for out-of-hospital cardiac arrest (OHCA).

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Background: The aim of this study was to assess whether hypothermia increased survival and improved functional outcome when compared with normothermia in out-of-hospital cardiac arrest (OHCA) patients with similar characteristics than in previous randomized studies showing benefits for hypothermia.

Methods: Post hoc analysis of a pragmatic, multicenter, randomized clinical trial (TTM-2, NCT02908308). In this analysis, the subset of patients included in the trial who had similar characteristics to patients included in one previous randomized trial and randomized to hypothermia at 33 °C or normothermia (i.

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  • Extracorporeal cardiopulmonary resuscitation (ECPR) utilizes extracorporeal membrane oxygenation (ECMO) to support patients experiencing refractory cardiac arrest, with survival outcomes heavily influenced by the patient's age.* -
  • Younger patients typically show better survival and neurological outcomes with ECPR, stressing the importance of age in clinical decision-making alongside other factors.* -
  • The review highlights disparities in survival rates between in-hospital and out-of-hospital cardiac arrests and discusses the potential of artificial intelligence in creating predictive models, while also raising ethical questions related to age-based treatment.*
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  • Hyperkalemia (HK) impacts the effectiveness of renin-angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with reduced ejection fraction (HFrEF).
  • The study analyzed patients with HFrEF and either HK or a history of HK during a run-in phase designed to optimize their RAS inhibitor and MRA doses using patiromer.
  • Results showed significant increases in the use of RAS inhibitors and MRAs among patients meeting the optimization criteria, indicating that patiromer helped enhance treatment for those with HK or a history of HK.
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Background: In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation may increase the survival chance. However, in cases of unsuccessful treatment, extracorporeal cardiopulmonary resuscitation may additionally provide an important source of organ donors. Therefore, we hypothesized that implementing extracorporeal cardiopulmonary resuscitation service into a high-volume cardiac arrest center's routine would increases organ donors' availability.

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Objectives: Bridging from a temporary microaxial left ventricular assist device (tLVAD) to a durable left ventricular assist device (dLVAD) is playing an increasing role in the treatment of terminally ill patients with heart failure. Scant data exist about the best implant strategy. The goal of this study was to analyse differences in the dLVAD implant technique and effects on patient outcomes.

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  • - The text discusses the lack of strong clinical evidence in the critical care of ECMO patients with acute brain injury (ABI) and presents guidelines for their neurological care.
  • - Guidelines were developed using input from an international panel of 30 ECMO experts through a structured voting process, focusing on five key clinical areas.
  • - The consensus emphasizes the importance of early detection and intervention for ABI in ECMO patients to improve health outcomes and outlines multiple recommendations to guide clinical practice and highlight research needs.
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  • Percutaneous active mechanical circulatory support (MCS) devices are increasingly used for treating acute myocardial infarction-related cardiogenic shock (AMICS), but there is mixed evidence on their impact on patients' mortality rates.
  • This study conducted an individual patient data meta-analysis of randomised controlled trials to assess the effect of early routine active MCS versus control treatments on 6-month all-cause mortality in AMICS patients.
  • The analysis included nine studies with a total of 1114 patients and found that four trials evaluated venoarterial extracorporeal membrane oxygenation (VA-ECMO) while five focused on left ventricular unloading devices, contributing valuable insights into their effectiveness in this patient group.
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  • A recent meta-analysis found that routine veno-arterial ECMO (VA-ECMO) does not improve outcomes for patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), while a specific microaxial flow pump did lower mortality in a certain patient group.
  • Individual patient data from four randomized trials were analyzed, focusing on patients similar to those in the DanGer-Shock trial, which aimed at understanding the 180-day all-cause mortality rates with VA-ECMO.
  • Despite a numerically lower 6-month mortality rate with VA-ECMO (45% vs. 51% in control), the risks of major bleeding and peripheral vascular complications were higher, suggesting no clear mortality benefit in this population.
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  • * This study aimed to explore long-term pulmonary perfusion issues in COVID-19 survivors who experienced severe acute respiratory distress syndrome (ARDS) and were treated with ECMO at a specific institution.
  • * Out of 80 patients who survived ECMO treatment, only 37 were analyzed; while VTE occurred frequently during acute illness, no ongoing pulmonary perfusion abnormalities were found after an average of 14 months post-ECMO.
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  • The use of temporary mechanical circulatory support (tMCS) in patients with cardiogenic shock has grown, primarily guided by observational studies and expert opinions.
  • Imaging plays a crucial role in every stage of patient care, from diagnosis to monitoring and eventual weaning from support.
  • This manuscript presents expert consensus and practical guidelines on the use of imaging in conjunction with tMCS, emphasizing evidence-based practices and current best standards.
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Background: We aimed to estimate the effect of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and mortality, when compared to conventional cardiopulmonary resuscitation (CCPR), using an individual patient data meta-analysis (IPDMA).

Methods: A systematic literature search was performed up to the 20th of October 2022 in the PubMed, EMBASE and CENTRAL databases. For observational studies with unmatched populations, a propensity score including age, location of arrest and initial rhythm was used to match ECPR and CCPR patients in a 1:1 ratio.

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  • The study evaluated the 1-year outcomes of the ECMO-CS trial, which compared immediate ECMO initiation to an early conservative approach in patients with severe cardiogenic shock.
  • Results showed no significant difference in all-cause mortality or other critical outcomes between the two strategies after one year.
  • However, there was a suggestion that immediate ECMO could be more beneficial for patients with significantly low mean arterial pressure at baseline, indicating a possible targeted use for this treatment strategy.
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  • The study looks at how the location where doctors put tubes in the arteries for heart support affects brain health after surgery.
  • They compared three methods: using the aorta, subclavian/axillary arteries, and femoral artery to see which had the least brain problems.
  • Results showed that patients using the subclavian/axillary method had more major brain issues compared to the others, and also had more seizures after the surgery.
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Background: It is unclear how invasive resuscitative protocols may impact the time-dependent prognosis of out-of-hospital cardiac arrest (OHCA) resuscitations, or the relationship between intra-arrest transport and outcomes.

Methods: We performed a secondary analysis of the Prague OHCA Study, which randomized refractory OHCAs to "invasive" (intra-arrest transport for possible ECPR initiation) vs. "standard" resuscitation strategies (predominantly performed on-scene).

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  • * Diagnosing NOMI is challenging, and treatment options are limited; its prevalence may depend on how long and how severely the intestines were deprived of blood during the cardiac arrest.
  • * NOMI is linked to worse neurological outcomes in cardiac arrest patients, indicating it should be viewed as both a complication and a potential predictor of prognosis in these individuals.
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Background: Induced hypothermia post-cardiac arrest is neuroprotective in animal experiments, but few high-quality studies have been performed in larger animals with human-like brains. The neuroprotective effect of postischemic hypothermia has recently been questioned in human trials. Our aim is to investigate whether hypothermia post-cardiac arrest confers a benefit compared to normothermia in large adult animals.

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  • ECLS cannulation in post-cardiotomy patients is uncommon in general wards, with only 39 out of 2058 patients studied undergoing the procedure while at the hospital.
  • The majority of these patients faced complications like acute kidney injury and arrhythmias, with a high in-hospital mortality rate of 84.6%, predominantly due to persistent heart failure.
  • Findings suggest that ECLS cannulation mainly affects low-risk patients who experience cardiac arrest post-surgery, indicating a need for further research into improving outcomes.
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  • A Bayesian meta-analysis was conducted to evaluate the effectiveness of extracorporeal cardiopulmonary resuscitation (ECPR) compared to conventional CPR in patients who had a cardiac arrest outside of the hospital, focusing on neurological outcomes after 6 months.
  • The analysis included data from three randomized trials, with ECPR involving 209 patients and conventional CPR involving 211 patients, and aimed to clarify the probability of clinically significant treatment effects rather than relying solely on p-values.
  • Results showed that ECPR had a median relative risk of 1.47 for neurologically favorable survival in all rhythms and 1.54 for patients with shockable rhythms, indicating a potential benefit, but with wide credible intervals suggesting uncertainty
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