Femoral versus Radial Approach for Primary Percutaneous Intervention in Cardiogenic Shock: A Subanalysis from the ECLS-SHOCK Trial.

Background: Cardiogenic shock (CS) is a life-threatening complication of acute coronary syndromes (ACS). Early revascularization with treating the culprit lesion improves survival. Nevertheless, the impact of access site (femoral vs.

Early Risk Stratification of Patients After Successfully Resuscitated Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation-The Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Risk Score.

Objectives: Existing scores for risk stratification after out-of-hospital cardiac arrest (OHCA) are either medically outdated, limited to registry data, small cohorts, and certain healthcare systems only, or include rather complex calculations. The objective of this study was to develop an easy-to-use risk prediction score for short-term mortality in patients with successfully resuscitated OHCA without ST-segment elevation on the post-resuscitation electrocardiogram, derived from the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial. The risk score was externally validated in the Coronary Angiography after Cardiac Arrest Trial (COACT) cohort (shockable arrest rhythms only) and additional hospitals from Berlin, Germany (shockable and nonshockable arrest rhythms).

Multi-dimensional outcomes following extracorporeal cardiopulmonary resuscitation.

Background: Recent trials suggested that extracorporeal cardio-pulmonary resuscitation (ECPR) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or "ECMELLA" (VA-ECMO plus Impella®) may improve short-term survival and neurological outcomes in selected patients with refractory cardiac arrest. However, long-term effects on cardiac, cognitive, physical and psychological health need further study. A multidisciplinary post-ECPR outpatient care program was developed at two centers, involving cardiologists, neurologists, psychologists and medical sociologists to assess seven key health dimensions.

Management of high-risk acute pulmonary embolism: an emulated target trial analysis.

Background: High-risk acute pulmonary embolism (PE) is a life-threatening condition necessitating hemodynamic stabilization and rapid restoration of pulmonary perfusion. In this context, evidence regarding the benefit of advanced circulatory support and pulmonary recanalization strategies is still limited.

Methods: In this observational study, we assessed data of 1060 patients treated for high-risk acute PE with 991 being included in a target trial emulation to investigate all-cause in-hospital mortality estimates with different advanced treatment strategies.

Association of Electrocardiographic Patterns After Successfully Resuscitated Out-of-Hospital Cardiac Arrest With Significant Coronary Lesions and Mortality-A Predefined Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation (TOMAHAWK) Trial.

Objectives: The use of electrocardiograms for predicting significant coronary lesions and mortality in patients with successfully resuscitated out-of-hospital cardiac arrest (OHCA) without ST-segment elevation has not been defined yet. The objective of this study was to investigate the association and predictive value of various standardized 12-lead electrocardiogram patterns in patients with successfully resuscitated OHCA and no ST-segment elevations on the presence of significant coronary lesions (diagnostic performance) and 30-day mortality (prognostic performance).

Design: Predefined subanalysis of the Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation (TOMAHAWK) trial.

Incidence and predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock.

Aims: This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS).

Methods And Results: Overall, 685 patients with CS treated with VA-ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49-66] years, 542 [79.1%] male, median lactate 7.

Critical reflection on the indication for computed tomography: an interdisciplinary survey of risk and benefit management in patients with sepsis.

Objectives: To survey physicians' views on the risks and benefits of computed tomography (CT) in the management of septic patients and indications for and contraindications to contrast media use in searching for septic foci.

Methods: A web-based questionnaire was administered to physicians at a large European university medical center in January 2022. A total of 371 questionnaires met the inclusion criteria and were analyzed with physicians' work experience, workplace, and medical specialty as independent variables.

C-reactive protein levels and outcomes in infarct-related cardiogenic shock: data from the ECLS-SHOCK trial.

Aims: The impact of systemic inflammation in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The present ECLS-SHOCK sub-study investigates the association of C-reactive protein (CRP) levels with short-term outcomes in patients with AMI-CS.

Methods And Results: Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial between 2019 and 2022 were included.

Risk scoring systems for early prediction of short-term mortality in resuscitated out-of-hospital cardiac arrest patients.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a critical condition associated with high mortality rates and neurological impairment among survivors. In comatose OHCA patients who achieve return of spontaneous circulation, early risk stratification is important to inform treatment pathways and potentially improve outcomes. A range of prognostic tools have been developed to predict survival and neurological recovery.

Bayesian Reanalyses of the Trials TOMAHAWK and COACT.

Background: The timing of coronary angiography in patients with successfully resuscitated out-of-hospital cardiac arrest and missing ST-segment elevations on the electrocardiogram has been investigated in 2 large randomized controlled trials, TOMAHAWK (Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation) and COACT (Coronary Angiography After Cardiac Arrest Trial). Both trials found neutral results for immediate vs delayed/selective coronary angiography on short-term all-cause mortality. The TOMAHAWK trial showed a tendency towards harm with immediate coronary angiography, though not statistically significant with traditional frequentist methods.

Left Atrial Appendage Closure after Ablation for Atrial Fibrillation.

Background: Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but data regarding its use after atrial fibrillation ablation are lacking.

Methods: We conducted an international randomized trial involving 1600 patients with atrial fibrillation who had an elevated score (≥2 in men and ≥3 in women) on the CHADS-VASc scale (range, 0 to 9, with higher scores indicating a greater risk of stroke) and who underwent catheter ablation.

Pre-assembled ECMO: Enhancing efficiency and reducing stress in refractory cardiac arrest care.

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest presents significant medical and psychological challenges for healthcare providers. Beyond managing cardiac arrest and preparing for potential coronary angiography, the ECMO circuit must be assembled and primed under strictly sterile conditions, contributing to additional psychological stress and potential delays in ECMO cannulation. This pragmatic study thought to evaluate whether pre-assembled and pre-primed ECMO circuits (pre-primed group) maintain sterility over a 21-day period, expedite ECMO initiation in ECPR patients and alleviate the psychological burden on the ECPR team, compared to newly assembled and primed ECMO circuits (on-demand group).

Microaxial Flow Pump Use and Renal Outcomes in Infarct-Related Cardiogenic Shock: A Secondary Analysis of the DanGer Shock Trial.

Background: In DanGer Shock (the Danish-German Cardiogenic Shock trial), use of a microaxial flow pump (mAFP) in patients with ST-segment-elevation myocardial infarction-related cardiogenic shock led to lower all-cause mortality but higher rates of renal replacement therapy (RRT). In this prespecified analysis, rates and predictors of acute kidney injury (AKI) and RRT were assessed.

Methods: In this international, randomized, open-label, multicenter trial, 355 adult patients with ST-segment-elevation myocardial infarction-related cardiogenic shock were randomized to mAFP (n=179) or standard care alone (n=176).

Microaxial Flow Pump Hemodynamic and Metabolic Effects in Infarct-Related Cardiogenic Shock: A Substudy of the DanGer Shock Randomized Clinical Trial.

Importance: Mechanical circulatory support with a microaxial flow pump (MAFP) has been shown to improve survival in ST-elevation myocardial infarction-induced cardiogenic shock (STEMI-CS). Understanding the impact on hemodynamic stability over time is crucial for optimizing patient treatment.

Objective: To determine if an MAFP reduces the need for pharmacological circulatory support without compromising hemodynamics compared with standard care in STEMI-CS.

Timing of veno-arterial extracorporeal membrane oxygenation support in patients with cardiogenic shock.

Aims: The optimal timing for implementing mechanical circulatory support (MCS) in cardiogenic shock (CS) remains indeterminate. This study aims to evaluate patient characteristics and outcome associated with the time interval between CS onset and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implementation.

Methods And Results: In this study, patients with CS treated with MCS at 15 tertiary care centres in three countries were enrolled.

Prognostic Impact of Admission Time in Infarct-Related Cardiogenic Shock: An ECLS-SHOCK Substudy.

Background: The outcomes of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) and the efficacy and safety of extracorporeal life support (ECLS) may be affected by the timing of hospital admission.

Objectives: The present ECLS-SHOCK substudy sought to investigate the prognostic impact of on-hours vs off-hours admission and the efficacy of ELCS according to the timing of hospital admission time in AMI-CS.

Methods: Patients with AMI-CS enrolled in the multicenter, randomized ECLS-SHOCK trial from 2019 to 2022 were included.

Left atrial appendage closure for stroke prevention in atrial fibrillation: current status and perspectives.

Atrial fibrillation (AF) is associated with an increased risk of stroke and systemic embolism, and the left atrial appendage (LAA) has been identified as a principal source of thromboembolism in these patients. While oral anticoagulation is the current standard of care, LAA closure (LAAC) emerges as an alternative or complementary treatment approach to reduce the risk of stroke or systemic embolism in patients with AF. Moderate-sized randomized clinical studies have provided data for the efficacy and safety of catheter-based LAAC, largely compared with vitamin K antagonists.

Sex and Age Characteristics in Acute or Chronic Myocarditis A Descriptive, Multicenter Cohort Study.

Background: Understanding the clinical features of myocarditis in various age groups is required to identify age-specific disease patterns.

Objectives: The objective of this study was to examine differences in sex distribution and clinical outcomes in patients with myocarditis of various ages.

Methods: Patients with acute or chronic myocarditis in 3 centers in Berlin, Germany from 2005 to 2021 and in the United States (National Inpatient Sample) from 2010 to 2019 were included.

Association of an impaired GH-IGF-I axis with cardiac wasting in patients with advanced cancer.

Background: Growth hormone (GH) resistance is characterized by high GH levels but low levels of insulin-like growth factor-I (IGF-I) and growth hormone binding protein (GHBP) and, for patients with chronic disease, is associated with the development of cachexia.

Objectives: We investigated whether GH resistance is associated with changes in left ventricular (LV) mass (cardiac wasting) in patients with cancer.

Methods: We measured plasma IGF-I, GH, and GHBP in 159 women and 148 men with cancer (83% stage III/IV).