Do we have our FACTTs straight about cor pulmonale in acute respiratory distress syndrome?

Aims: The incidence of cor pulmonale in acute respiratory distress syndrome is roughly 20-25% and is associated with nearly 50% increase in mortality risk. Our primary aim was to quantify the association of traditional cor pulmonale risk factors {pH, PaO2:FiO2 ratio, PaCO2, and driving pressure [plateau pressure minus the positive end-expiratory pressure (PEEP)]} and PEEP with the mentioned cor pulmonale parameters.

Methods And Results: Using data from the FACTT trial, we examined four cor pulmonale parameters.

A Scoping Review of Definitions of Success in Endovascular Aortic Arch Repair.

Introduction: The present standard of care to treat aortic arch pathologies is open surgical repair with cardiopulmonary bypass and deep hypothermic arrest. With approaches for total endovascular and extra-anatomic cervical debranching hybrid arch repair becoming more diverse, understanding what is considered a successful operation is prerequisite for a rigorous comparison of techniques. This review describes the specific outcomes reported, the rates of success, and the definitions of technical and clinical success in total endovascular and extra-anatomic cervical debranching hybrid aortic arch repair.

The Roles of Venopulmonary Arterial Extracorporeal Membrane Oxygenation.

Objectives: Concise definitive review of the use of venopulmonary arterial extracorporeal membrane oxygenation (V-PA ECMO) support in patients with cardiopulmonary failure.

Data Sources: Original investigations identified through a PubMed search with search terms "percutaneous right ventricular assist device," "oxy-RVAD," "V-PA ECMO," and "veno-pulmonary arterial ECMO" were reviewed and evaluated for relevance.

Study Selection: Studies that included more than three patients supported with V-PA ECMO were included.

Stable Ventricular Fibrillation: A Paradigm Rather Than Septal Shift?

Awake patients in ventricular fibrillation is a phenomenon limited to patients who are mechanically supported. We describe a cohort of patients supported by left ventricular assist devices (LVADs) presenting to the emergency department (ED) at a high-volume LVAD center while in awake ventricular fibrillation (VF)/ventricular tachycardia (VT). Among 175 patients reviewed, a total of 19 LVAD patients presented to the ED in awake VF/VT between December 2015 and July 2021.

Multiorgan evaluation of perfusion and congestion using ultrasound in patients with shock.

There is increasing evidence on the role of ultrasound in the evaluation of multiorgan hypoperfusion and congestion in patients with cardiocirculatory shock both to identify the underlying pathophysiological mechanism and to drive and monitor the treatment. The cardiac and lung ultrasound is included as an integrated multiparametric approach to the very early phase of patients with haemodynamic instability/cardiogenic shock. Splanchnic ultrasound has been mainly applied in heart failure and predominant circulatory failure.

Right ventricle-specific therapies in acute respiratory distress syndrome: a scoping review.

Objective: To summarize knowledge and identify gaps in evidence regarding treatment of right ventricular dysfunction (RVD) in acute respiratory distress syndrome (ARDS).

Data Sources: We conducted a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials.

Study Selection: Studies were included if they reported effects of treatments on right ventricular function, whether or not the intent was to modify right ventricular function.

The Role of Echocardiography in Extracorporeal Membrane Oxygenation.

Purpose Of Review: Extracorporeal membrane oxygenation (ECMO) is increasingly used to temporarily support patients in severe circulatory and/or respiratory failure. Echocardiography is a core component of successful ECMO deployment. Herein, we review the role of echocardiography at different phases on extracorporeal support including candidate identification, cannulation, maintenance, complication vigilance, and decannulation.

Transthoracic Right Heart Echocardiography for the Intensivist.

Background: The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature.

Institutional Experience With Venoarterial Extracorporeal Membrane Oxygenation for Massive Pulmonary Embolism: A Retrospective Case Series.

Objective: Despite advances in treatment, massive pulmonary embolism (PE) remains associated with significant morbidity and mortality. The role of venoarterial extracorporeal membrane oxygenation (VA ECMO) in the setting of massive PE is evolving and includes potential roles both in initial management and as a rescue strategy.

Design: Single-center case series that reported demographics and outcomes for patients with massive PE who underwent VA ECMO.

Experience With Cardiology-Oriented Outcomes in Critically Ill Patients With Coronavirus Disease 2019.

Objectives: Coronavirus disease 2019 is associated with high mortality rates and multiple organ damage. There is increasing evidence that these patients are at risk for various cardiovascular insults; however, there are currently no guidelines for the diagnosis and management of such cardiovascular complications in patients with coronavirus disease 2019. We share data and recommendations from a multidisciplinary team to highlight our institution's clinical experiences and guidelines for managing cardiovascular complications of coronavirus disease 2019.

Continuous-flow left ventricular assist devices: Management in the emergency department.

With an increasing number of left ventricular assist devices (LVADs) being placed every year, emergency clinicians are increasingly likely to encounter them in their practice. Patients may present to the emergency department (ED) with significant hemodynamic perturbations with an LVAD and it is imperative that emergency clinicians are able to assess and treat conditions contributing to low cardiac output states. This review describes the important aspects of the third generation of LVADs and their complications as well as common management approaches for the emergency physician.

Timing of Intubation and Mortality Among Critically Ill Coronavirus Disease 2019 Patients: A Single-Center Cohort Study.

Objectives: Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019.

Design: Retrospective cohort study.

Platelet Dysfunction Diseases and Conditions: Clinical Implications and Considerations.

Introduction: Platelet diseases and dysfunction are taught early in medical school to all future physicians. Understanding of the coagulation cascade and hemostatic mechanisms has allowed for targeted pharmacological therapies that have been significantly impactful in clinical practice. Platelets are an early participant in hemostasis physiologically and under pathophysiological states.

Vasoplegia after cardiopulmonary bypass: A narrative review of pathophysiology and emerging targeted therapies.

Cardiovascular disease remains the leading cause of death in the United States, and cardiopulmonary bypass is a cornerstone in the surgical management of many related disease states. Pathophysiologic changes associated both with extracorporeal circulation and shock can beget a syndrome of low systemic vascular resistance paired with relatively preserved cardiac output, termed vasoplegia. While increased vasopressor requirements accompany vasoplegia, related pathophysiologic mechanisms may also lead to true catecholamine resistance, which is associated with further heightened mortality.