Publications by authors named "P. Elliott Miller"
Background: The use of mechanical circulatory support devices for high-risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra-aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI.
Methods And Results: This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022.
Acute decompensated valvular disease encompasses a group of complex and challenging conditions, which are often the primary reason for admission to the cardiac intensive care unit and can also complicate the management of other primary cardiac disorders. Critically ill patients with valvular disease also present unique diagnostic and management challenges. Historically, medical and percutaneous interventional therapies have been limited and surgery was the only definitive treatment; however, surgical risk can at times be prohibitive.
View Article and Find Full Text PDFPatients undergoing cardiac surgery experience significant physiologic derangements that place them at risk for multiple shock phenotypes. Any combination of cardiogenic, obstructive, hemorrhagic, or vasoplegic shock occurs commonly in post-cardiotomy patients. The approach to the diagnosis and management of these shock states has many facets that are distinct compared to non-surgical cardiac intensive care unit patients.
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- * They focused on adult education fundamentals, necessary training for high-quality patient care, and emphasized diversity, equity, and inclusion.
- * The resulting paper serves as a guide for trainees, providing insights on the current state of critical care cardiology and outlining future directions for the field’s growth.
Article Synopsis
- - The study investigated the outcomes of patients with acute myocardial infarction (AMI) who required invasive mechanical ventilation, comparing those in medical ICUs (MICU) versus cardiac ICUs (CICU) from October 2015 to December 2019.
- - Among the 12,639 patients studied, those in the CICU had a higher prevalence of serious conditions, but overall ventilator days were similar between both ICUs and in-hospital mortality rates were not significantly different until statistical adjustments were made.
- - The results indicated that admission to the CICU was linked to lower in-hospital mortality rates for AMI patients, suggesting that better triage to specialized cardiac care could improve outcomes.
Epidemiology of cardiogenic shock using the Shock Academic Research Consortium (SHARC) consensus definitions.
Eur Heart J Acute Cardiovasc Care
October 2024
Article Synopsis
- The Shock Academic Research Consortium (SHARC) created standardized definitions for cardiogenic shock (CS) to improve classification in clinical settings and studies.
- A study using these definitions observed a total of 8,974 patients, finding that 65% had isolated CS, with significant variations in causes such as acute myocardial infarction and heart failure.
- Results indicated that patients with mixed CS had the highest mortality rate (48%), while acute-on-chronic heart failure presented the lowest (25%), highlighting the need for targeted treatment strategies based on CS subtypes.
Article Synopsis
- The study investigates current management practices for patients using temporary mechanical circulatory support (tMCS) devices like intra-aortic balloon pumps and Impella in North American cardiac intensive care units.
- An online survey was conducted, with a response rate of 84% from 37 centers, focusing on hemodynamic monitoring, hemocompatibility, and weaning/removal of the devices.
- Results showed significant variability in how these practices are implemented, indicating a need for standardized guidelines to improve patient outcomes with tMCS.
Background: The role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database.
Methods: Using the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization.
Study Objective: Temperature control trials in cardiac arrest patients have not reliably conferred neuroprotective benefit but have been limited by inconsistent treatment parameters. To evaluate the presence of a time dependent treatment effect, we assessed the association between preinduction time and clinical outcomes.
Methods: In this retrospective, single academic center study between 2014 and 2022, consecutive out-of-hospital cardiac arrest (OHCA) patients treated with temperature control were identified.
Arterial hyperoxia and mortality in the cardiac intensive care unit.
Curr Probl Cardiol
October 2024
Article Synopsis
- Arterial hyperoxia (high levels of oxygen in the blood) is linked to worse outcomes in critically ill patients, but its effects in cardiac intensive care units (CICUs) have not been previously studied.
- A study of over 3,300 patients showed a J-shaped relationship between oxygen levels at admission and in-hospital mortality, with a significant increase in risk for those with PaO2 levels over 300 mmHg.
- The findings suggest that higher oxygen levels upon admission to the CICU are associated with increased mortality, particularly for patients with severely elevated PaO2 levels.
Background: Proton pump inhibitors (PPIs) and histamine type 2-receptor blockers (H2Bs) are commonly used for stress ulcer prophylaxis among patients requiring invasive mechanical ventilation (IMV). Recent studies suggest an increased mortality associated with PPIs compared to H2Bs, but these studies poorly represent patients with cardiovascular disease or acute myocardial infarction (AMI).
Objectives: The aim of this study was to compare outcomes related to stress ulcer prophylaxis with PPIs compared to H2Bs in patients with AMI requiring IMV.
Objective: Patients with acute myocardial infarction (AMI) complicated by respiratory failure require antiplatelet regimens which often cannot be stopped and may increase bleeding from tracheostomy. However, there is limited available data on both the proportion of patients undergoing tracheostomy and the impact on antiplatelet regimens on outcomes.
Methods: Utilizing the Vizient® Clinical Data Base, we identified patients ≥18 years admitted from 2015 to 2019 with a primary diagnosis of AMI and requiring invasive mechanical ventilation (IMV).
This review aims to enhance the comprehension and management of cardiopulmonary interactions in critically ill patients with cardiovascular disease undergoing mechanical ventilation. Highlighting the significance of maintaining a delicate balance, this article emphasizes the crucial role of adjusting ventilation parameters based on both invasive and noninvasive monitoring. It provides recommendations for the induction and liberation from mechanical ventilation.
View Article and Find Full Text PDFBackground: Associations of early changes in vasoactive support with cardiogenic shock (CS) mortality remain incompletely defined.
Methods: The Critical Care Cardiology Trials Network is a multicenter registry of cardiac intensive care units. Patients admitted with CS (2018-2023) had vasoactive dosing assessed at 4 and 24 hours from cardiac intensive care unit admission and quantified by the vasoactive-inotropic score (VIS).
Over the last several decades, the cardiac intensive care unit (CICU) has seen an increase in the complexity of the patient population and etiologies requiring CICU admission. Currently, respiratory failure is the most common reason for admission to the contemporary CICU. As a result, noninvasive ventilation (NIV), including noninvasive positive-pressure ventilation and high-flow nasal cannula, has been increasingly utilized in the management of patients admitted to the CICU.
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- Patients with acute myocardial infarction (AMI) who require invasive mechanical ventilation (IMV) show high mortality rates, and the study focuses on how different induction agents affect their outcomes.
- This research analyzed data from 5,147 AMI patients receiving IMV between 2015 and 2019, comparing outcomes between those induced with propofol and etomidate.
- Results indicated that propofol use resulted in lower mortality than etomidate (32.3% vs 36.1%), suggesting the need for further randomized trials to identify the best induction agent for these critically ill patients.
Article Synopsis
- Cardiogenic shock remains a critical health issue with high mortality rates, and no significant new treatments have emerged in decades, making management difficult.
- A collaborative, multidisciplinary approach involving specialized "shock teams" is being promoted to improve patient outcomes in high-volume clinical settings.
- The proposal aims to establish a Cardiogenic Shock Team Collaborative to enhance care protocols, education, and overall performance, similar to successful initiatives in other medical areas.
Article Synopsis
- A study was conducted to assess the clinical characteristics and outcomes of patients in a cardiac intensive care unit (CICU) who were referred for cardiac surgery from 2017 to 2020 across 29 medical centers.
- Out of 10,321 CICU admissions, 887 patients (8.6%) underwent various types of cardiac surgery, with common admission issues including shock and respiratory insufficiency.
- The overall in-hospital mortality rate for these CICU patients was 11.7%, but those who had surgery had a lower rate of 9.1%, suggesting that clinicians effectively managed higher acuity patients with acceptable risks during surgery.
Transatlantic collaboration detailing research priorities in critical care cardiology.
Eur Heart J Acute Cardiovasc Care
February 2024
Article Synopsis
- The cardiac intensive care unit (CICU) has changed significantly in terms of the types of patients and their medical conditions over the years, but high-quality evidence for managing these patients is still lacking.
- Due to a shortage of clinical trials focused specifically on critical care cardiology (CCC), clinicians often have to rely on studies that don't accurately reflect their patient population.
- The text outlines major research priorities for CCC, highlights the challenges faced in CICU investigations, and suggests necessary steps for advancing the field.
Background And Objectives: Brain death (BD) occurs in 9-24% of successfully resuscitated out-of-hospital cardiac arrests (OHCA). To predict BD after OHCA, we developed a novel brain death risk (BDR) score.
Methods: We identified independent predictors of BD after OHCA in a retrospective, single academic center cohort between 2011 and 2021.
Prognostic significance of haemodynamic parameters in patients with cardiogenic shock.
Eur Heart J Acute Cardiovasc Care
October 2023
Article Synopsis
- Invasive haemodynamic assessment using a pulmonary artery catheter is important for managing patients with cardiogenic shock (CS) and understanding their prognosis.
- A study analyzed data from a multicenter registry involving patients with CS to find relationships between their haemodynamic parameters and outcomes like in-hospital mortality and end-organ dysfunction.
- Key findings indicated that lower mean arterial pressure, lower systolic blood pressure, and other specific haemodynamic metrics were linked to worse outcomes and higher serum lactate levels, suggesting severe circulatory issues.