An Unusual Cause of Shock: Bursting a Bubble.

This study presents the case of a previously healthy 68-year-old woman who presented with shock from tamponade due to hemopericardium. Initial noninvasive imaging did not provide a clear etiology for the hemopericardium. Given the ongoing clinical deterioration and need for diagnosis and treatment, an exploratory sternotomy was performed with successful outcome.

Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Clinical Practice Update on Optimal Post Cardiac Arrest and Refractory Cardiac Arrest Patient Care.

Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society's position statement on OHCA care, multiple randomized controlled trials have helped to better define optimal post cardiac arrest care. This working group provides updated guidance on the timing of cardiac catheterization in patients with ST-elevation and without ST-segment elevation, on a revised temperature control strategy targeting normothermia instead of hypothermia, blood pressure, oxygenation, and ventilation parameters, and on the treatment of rhythmic and periodic electroencephalography patterns in patients with a resuscitated OHCA.

Association of Surrogate Decision-making Interventions for Critically Ill Adults With Patient, Family, and Resource Use Outcomes: A Systematic Review and Meta-analysis.

Importance: Physicians often rely on surrogate decision-makers (SDMs) to make important decisions on behalf of critically ill patients during times of incapacity. It is uncertain whether targeted interventions to improve surrogate decision-making in the intensive care unit (ICU) reduce nonbeneficial treatment and improve SDM comprehension, satisfaction, and psychological morbidity.

Objective: To perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to determine the association of such interventions with patient- and family-centered outcomes and resource use.

Risk Stratification of an Accessory Pathway Using Isoproterenol after Cardiac Arrest.

A 43-year-old man presented after ventricular fibrillation cardiac arrest with evidence of pre-excited atrial fibrillation. Electrophysiology study with guideline-directed testing demonstrated a low risk accessory pathway effective refractory period, which became high-risk with isoproterenol infusion. This case represents a challenging scenario wherein a high-risk pathway may be misclassified using the currently indicated methods of risk stratification.

Clot or Not?

• A case of exertional dyspnea was found to be symptomatic right ventricular masses. • Echocardiography is the first-line imaging modality for cardiac masses. • Cardiac MRI is useful for tissue characterization of cardiac masses.