CANCARE RESEARCH
Explore previously published research highlights by topic, study type or publication date.
An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Real-time feedback during bag-valve-mask ventilation for out-of-hospital cardiac arrest: a before-and-after study (VEntilation during Cardiac Arrest Resuscitation Study, VECARS-2).
Clinical takeaway Feedback was associated with better control of insufflated volume, but this did not translate into a demonstrated improvement in expiratory tidal volume. Patient-centred benefits remain unestablished.
Summary & abstract
Study summary
This before-and-after study evaluated real-time bag-valve-mask ventilation feedback during adult out-of-hospital cardiac arrest, analyzing 4,300 ventilations in 163 patients. Insufflated volume was within 400–600 mL in 68% of ventilations with feedback versus 42% without, whereas expiratory tidal volume met that range in 14% versus 15%. Median expiratory tidal volume was 235 versus 243 mL with and without feedback, respectively (p=0.84). Feedback was associated with less variable insufflated volumes (within-patient IQR ratio 0.65; 95% CI 0.53–0.77) and lower leak volume (adjusted mean ratio 0.88; 95% CI 0.77–0.99).
Study limitation: Sequential observational cohorts limit causal inference; the abstract reports ventilation measures rather than survival or neurological outcomes.
Published abstract
This study compared bag-valve-mask ventilation quality and adherence to the guideline-recommended ventilation volume range during 30:2 cardiopulmonary resuscitation for out-of-hospital cardiac arrest before and after the implementation of real-time feedback. We conducted a before-and-after observational study of two sequential adult cohorts with out-of-hospital cardiac arrest managed by basic life support teams from the Paris Fire Brigade. A bidirectional sensor measured insufflated volume (Vi) and expiratory tidal volume (Vt). The display was masked during Period-1 and provided real-time feedback during Period-2. We assessed adherence to the guideline-recommended range using mixed-effects regression; we analyzed Vt and leak volume using gamma log-link generalized linear mixed models. We analyzed 4,300 ventilations in 163 patients, 96 without feedback and 67 with feedback. Median Vi was lower with feedback (471 mL) than without (513 mL, p=0.03 for the first ventilation of each cycle) but median Vt was unchanged (235 vs. 243 mL, p=0.84). Vi dispersion was reduced by 35% (mean within-patient IQR ratio 0.65 [95%-CI, 0.53-0.77]). Vi was 400-600 mL in 68% of ventilations with feedback vs. 42% without feedback. In contrast, Vt was 400-600 mL in only 14% of ventilations with feedback vs. 15% without feedback. In multivariable analysis, leak volume was 12% lower with feedback (mean ratio, 0.88 [95%-CI, 0.77-0.99]). Real-time feedback was associated with improved adherence to the guideline-recommended range for Vi, less dispersed Vi,and lower leak volume. Causal inference, clinical significance, and generalizability warrant further evaluation.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Association between burst-suppression with identical bursts and multimodal measures of cerebral oxygenation after cardiac arrest.
Clinical takeaway These physiological associations suggest a potentially distinct pattern of post-arrest brain injury. They do not establish a modifiable mechanism or demonstrate implications for neurological recovery.
Summary & abstract
Study summary
This single-centre retrospective study examined cerebral oxygenation across EEG patterns after cardiac arrest, including 109 patients monitored with jugular bulb oxygen saturation and 33 with brain tissue oxygen tension. Burst-suppression with identical bursts was associated with higher jugular saturation than non-malignant patterns (β=12; 95% CI, 7.0 to 16.0). Compared with malignant patterns, it was associated with lower intracranial pressure (β=-19.0; 95% CI, -32.5 to -5.6). Brain tissue oxygen tension was numerically higher than with malignant patterns, but the adjusted estimate was uncertain (β=4.0; 95% CI, -4.7 to 13.0).
Study limitation: Single-centre retrospective data from selected monitored patients, including only 33 with brain tissue oxygen monitoring, limit causal interpretation and generalisability.
Published abstract
OBJECTIVE: Burst-suppression with identical bursts (BSIB) is an electroencephalographic (EEG) pattern associated with severe post-cardiac arrest brain injury (PCABI). Whether modifiable mechanisms of brain injury underlie BSIB is unknown. We hypothesized BSIB is associated with impaired cerebral oxygen metabolism, reflected as pathologically elevated jugular bulb venous oxygen saturation (SjvO2), higher brain tissue oxygen tension (PbtO2), normal jugular bulb venous-to-arterial carbon dioxide gradient (PbCO2 gap, and lower intracranial pressure (ICP) compared to other EEG patterns. METHODS: This single-center retrospective study included patients resuscitated from cardiac arrest who underwent EEG and SjvO2 or PbtO2 monitoring. We categorized EEG patterns as BSIB, malignant without BSIB, and non-malignant. Using mixed effects linear regression, we examined associations between EEG and SjvO2, PbCO2 gap, PbtO2, and ICP. RESULTS: The SjvO2 and PbtO2 cohorts included 109 and 33 patients, respectively. SjvO2 did not differ between BSIB and malignant EEGs (β=3; 95% CI, -0.6 to 7.0), butwas higher with BSIB compared to non-malignant patterns (β=12; 95% CI, 7.0 to 16.0). BSIB was associated with lower PbCO2 gap compared to malignant (β=-1.4; 95% CI, -2.6 to -0.3) and non-malignant (β=-2.6; 95% CI, -4.1 to -1.0) patterns. PbtO2 was highest with BSIB, but not significantly higher compared to malignant patterns in our adjusted model (β=4.0; 95% CI, -4.7 to 13.0). ICP was lower in those with BSIB compared to malignant patterns (β=-19.0; 95% CI, -32.5 to -5.6). Interpretation BSIB may represent a distinct subtype of PCABI characterized by impaired oxygen metabolism with preserved oxygen delivery and diffusion.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Regional implementation of a prehospital advanced life support program with video-assisted physician direction and outcomes after out-of-hospital cardiac arrest.
Clinical takeaway Regional implementation was associated with increased prehospital ROSC, but no demonstrated improvement in discharge survival or favorable neurological outcome. These observational findings do not establish a causal benefit.
Summary & abstract
Study summary
This South Korean retrospective cohort included 129,207 adult out-of-hospital cardiac arrests and compared regional changes after implementation of video-assisted physician-directed advanced life support using difference-in-differences analyses. Compared with nonimplementing regions, implementing regions had a greater increase in prehospital ROSC: 1.35 percentage points (95% CI, 0.56 to 2.15). There were no significant additional improvements in survival to discharge (−0.35 percentage points; 95% CI, −1.31 to 0.62) or favorable neurological outcome (−0.35 percentage points; 95% CI, −1.08 to 0.37). Prehospital time increased by an additional 4.12 minutes (95% CI, 2.91 to 5.33).
Study limitation: The observational design limits causal inference, and differential pre-intervention trends specifically weaken interpretation of the prehospital time finding.
Published abstract
BACKGROUND: The smart advanced life support (SALS) program was introduced to provide prehospital advanced life support under real-time video-assisted physician direction for out-of-hospital cardiac arrest (OHCA). This study evaluated the association between regional SALS implementation and OHCA outcomes. METHODS: This retrospective cohort study used difference-in-differences and event-study analyses with data from the OHCA surveillance system in South Korea and included adult OHCA cases (aged ≥19 years) from 2 years before through 4 years after SALS implementation in August 2015. The exposure was region-level implementation of SALS. Outcomes were the prehospital time interval, prehospital return of spontaneous circulation (ROSC), survival to discharge, and favorable neurological outcome. Pre- to post-implementation changes were compared between regions with and without SALS. RESULTS: A total of 129,207 cases were included. SALS regions had greater increases in the prehospital time interval (4.12 minutes; 95% confidence interval [CI], 2.91 to 5.33) and prehospital ROSC (1.35 percentage points; 95% CI, 0.56 to 2.15) than regions without SALS. No significant additional improvements were observed in survival to discharge (-0.35 percentage points; 95% CI, -1.31 to 0.62) or favorable neurological outcome (-0.35 percentage points; 95% CI, -1.08 to 0.37). Event-study analyses suggested differential pre-intervention trends for prehospital time, but not for the other outcomes. CONCLUSION: SALS regions showed greater increases in prehospital time and prehospital ROSC without significant improvements in survival to discharge or favorable neurological outcome, but the finding for prehospital time should be interpreted cautiously because differential pre-intervention trends were observed.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Fatigue, Anxiety and Depression 12 Months After Out-of-Hospital Cardiac Arrest: A Population Based Cohort Study.
Clinical takeaway Persistent symptoms are an important component of cardiac-arrest survivorship beyond hospital discharge. Their association with poorer recovery highlights a patient-centred outcome domain, without establishing causality or an effective intervention.
Summary & abstract
Study summary
This prospective Australian cohort assessed 728 adult out-of-hospital cardiac arrest survivors at 12 months, representing 68.2% of eligible survivors. Fatigue affected 35.8% (250/699), anxiety 22.6% (162/716), and depression 18.0% (129/716). Higher symptom burden was associated with poorer quality of life, worse functional recovery and reduced return to work. Compared with population norms, fatigue was greater (standardized mean difference 0.64; 95% confidence interval 0.50–0.78), while depression was slightly greater and anxiety lower. These findings describe substantial symptom burden among survivors but do not establish that symptoms cause poorer recovery.
Study limitation: Only 68.2% of eligible 12-month survivors completed follow-up, creating potential nonresponse bias; observational associations cannot establish causality.
Published abstract
AIM: To determine the prevalence and factors associated with fatigue, anxiety, and depression 12 months after out-of-hospital cardiac arrest (OHCA); examine their associations with health-related quality of life (HRQoL) and functional recovery; and compare symptom burden with population norms. METHODS: This prospective, population-based cohort study included adults (≥18 years) who received EMS-attempted resuscitation and survived to hospital discharge following non-traumatic OHCA in Victoria, Australia, between July 2019 and June 2022. Survivors were identified from a statewide OHCA registry and completed a 12-month telephone interview. Primary outcomes were fatigue (Modified Fatigue Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale). Secondary outcomes included HRQoL (EQ-5D, SF-12), functional recovery (GOSE), living arrangement, and return to work. RESULTS: Of 1068 eligible 12-month survivors, 728 (68.2%) completed follow-up (median age 61 years; 555 [76.2%] male). Fatigue was reported by 35.8% (250/699), anxiety by 22.6% (162/716), and depression by 18.0% (129/716). Higher symptom burden was associated with lower EQ-5D and SF-12 scores, worse GOSE outcomes (all p<0.001) and reduced return-to-work rates. Compared with population norms, survivors reported greater fatigue (SMD 0.64; 95%CI, 0.50-0.78;p<0.001), and depression (SMD, 0.12; 95%CI, 0.02,0.21;p=0.02) but lower anxiety (SMD, -0.27; 95%CI, -0.35 to -0.18;p<0.001). In adjusted models, younger age, preexisting anxiety or depression, diabetes and initial non-shockable arrest were associated with higher symptom burden, whereas EMS-witnessed arrests were associated with lower symptom burden. CONCLUSIONS: Fatigue, anxiety, and depression were common at 12 months after OHCA and are associated with poorer recovery. Fatigue exceeded population norms and may be an under-recognised component of cardiac arrest survivorship.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Effects of inhaled nitric oxide during mechanical circulatory support: a prospective pilot study.
Clinical takeaway Inhaled nitric oxide was temporally associated with an early reduction in pulmonary artery pressure during Impella-based support. This pilot does not establish clinical benefit or a causal haemodynamic effect.
Summary & abstract
Study summary
This prospective single-centre pilot evaluated inhaled nitric oxide in adults with cardiogenic shock receiving Impella or ECPELLA support; 11 patients were enrolled and 10 analysed. The primary endpoint was change in mean pulmonary artery pressure at 30 minutes, which decreased from 19.0 to 16.5 mmHg (P=0.004). The baseline-to-24-hour difference was not significant, and no clear improvement in systemic haemodynamic indices was observed. Lactate decreased, but without a control group this temporal change could not be attributed directly to inhaled nitric oxide.
Study limitation: Only 10 patients were analysed at one centre without a control group, limiting causal interpretation and generalisability.
Published abstract
Among patients with cardiogenic shock receiving Impella-based mechanical circulatory support, pulmonary vascular load and right ventricular dysfunction may affect left ventricular preload and device flow. Prospective data on the acute hemodynamic effects of inhaled nitric oxide (iNO) in this setting are limited. We evaluated short-term hemodynamic changes after iNO initiation in patients receiving Impella or Impella combined with veno-arterial extracorporeal membrane oxygenation (ECPELLA) support. We conducted a prospective single-center pilot study of adult patients receiving Impella or ECPELLA support who were treated with iNO. iNO was initiated at 20 ppm after initial circulatory resuscitation once pulmonary artery pulse pressure could be reliably assessed. Hemodynamic variables were recorded immediately before iNO initiation (T0) and 30 min (T1) and 24 h (T2) after initiation. The primary endpoint was the change in mean pulmonary artery pressure (mPAP) from T0 to T1. We enrolled 11 patients, and 10 were analyzed. mPAP decreased from 19.0 (14.8-20.3) mmHg at T0 to 16.5 (12.8-19.3) mmHg at T1 (P = 0.004). The T0-T2 difference was not significant. Lactate levels decreased, but this temporal change could not be attributed directly to iNO without a control group. Methemoglobin levels increased slightly at T2 without clinical methemoglobinemia. iNO was temporally associated with an early reduction in mPAP in patients receiving Impella-based support, without clear improvement in systemic hemodynamic indices. These hypothesis-generating findings require confirmation in larger controlled studies.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Association Between Blood Pressure Response Index and Prognosis in Patients with Septic Shock Caused by Pneumonia.
Clinical takeaway BPRI may offer prognostic information in pneumonia-associated septic shock. These observational findings do not establish that targeting BPRI improves outcomes or that it should guide vasopressor management.
Summary & abstract
Study summary
A mixed retrospective and prospective cohort study examined the blood pressure response index (BPRI), defined as mean arterial pressure divided by vasoactive inotropic score, in pneumonia-associated shock. The retrospective cohort included 618 patients and the prospective cohort 65 patients. Higher BPRI was associated with lower mortality risk in the retrospective analysis (adjusted hazard ratio 0.843; 95% confidence interval 0.811–0.877). For 30-day mortality, BPRI discrimination was numerically higher than either component alone, with an area under the curve of 0.7404 (95% interval 0.7018–0.7790), and prospective findings were consistent.
Study limitation: The prospective cohort was small, and the abstract does not specify the BPRI measurement timing or the adjustment variables.
Published abstract
BackgroundNo noninvasive index exists to assess vasopressor responsiveness for maintaining blood pressure in severe pneumonia-induced shock. This study evaluated the association between the blood pressure response index (BPRI) and prognosis in such patients.MethodsA mixed retrospective and prospective cohort study analyzed clinical data from patients admitted to tertiary hospitals between January 2018 and January 2025. BPRI is the ratio between the mean arterial pressure and the vasoactive inotropic score. Cox regression analysis assessed the impact of BPRI on mortality risk, while Kaplan-Meier curves compared 30-day cumulative survival rates across BPRI tertiles. The receiver operating characteristic (ROC) curves evaluated BPRI's predictive accuracy for mortality. Restricted cubic spline (RCS) analysis explored potential nonlinear relationships between BPRI and mortality risk.ResultsThe retrospective cohort included 618 patients, with 332 (52.7%) fatalities. In the prospective cohort, 65 patients were enrolled, with 30 (46.2%) death. Cox regression analysis of the retrospective dataset indicated that higher BPRI values correlated with lower mortality risk (adjusted hazard ratio [HR]= 0.843, 95% confidence interval [CI] [0.811, 0.877]). The ROC analysis demonstrated that BPRI predicted 30-day mortality (area under the curve [AUC] = 0.7404, 95%=[0.7018,0.7790]) more accurately than the vasoactive inotropic score (AUC=0.7034, 95%CI = [0.6627,0.7440]) and mean arterial pressure (AUC=0.6638, 95%CI = [0.6201,0.7075]), consistent with prospective findings. The RCS analysis revealed a nonlinear relationship between BPRI and mortality risk, with a cutoff value of 9.05.ConclusionA lower BPRI was significantly associated with increased mortality risk, following a nonlinear pattern. BPRI demonstrated substantial predictive value for severe pneumonia-induced shock.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Clinical significance of elevated body temperature without infection following removal of VA-ECMO.
Clinical takeaway Temperature elevation after VA-ECMO removal was common but did not distinguish overall mortality in this cohort. The association between larger temperature rises and mortality within the elevated-temperature subgroup is exploratory.
Summary & abstract
Study summary
This retrospective study evaluated 163 cardiogenic shock patients without evidence of infection undergoing VA-ECMO removal. Temperature reached at least 38.0°C within 24 hours in 58.9%, accompanied by lower systolic blood pressure and systemic vascular resistance and higher lactate. All-cause mortality was 30.2% with versus 29.9% without elevated temperature (log-rank p=0.983). Among patients with elevated temperature, a greater temperature rise, particularly at least 1.1°C, was associated with higher all-cause mortality (HR 1.968, 95% CI 1.096–3.535); the abstract did not specify the mortality follow-up duration.
Study limitation: The retrospective design limits causal interpretation, and the subgroup association requires confirmation; mortality follow-up duration was not reported.
Published abstract
BACKGROUND: Previous studies have reported elevated body temperature following the removal of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, the clinical implications of elevated body temperature after the removal of VA-ECMO remain unknown. OBJECTIVES: To characterize elevated body temperature after VA-ECMO removal in patients with cardiogenic shock (CS). METHODS: We retrospectively evaluated 163 CS patients undergoing VA-ECMO removal. All patients did not exhibit any evidence of infection. Blood temperature was continuously monitored using a Swan-Ganz catheter. Elevated body temperature was defined as a maximum body temperature ≥38.0 °C within 24 h after VA-ECMO removal. All-cause mortality was compared between patients with and without elevated body temperature. RESULTS: Elevated body temperature was observed in 58.9% (96/163) of study subjects. Patients with elevated body temperature had higher C-reactive protein (CRP) levels (11.1 ± 8.6 vs. 8.5 ± 6.1 mg/dL, p = 0.027), accompanied by reductions in systolic blood pressure and systemic vascular resistance, and increased lactate levels. CRP levels independently predicted elevated body temperature (OR=1.050, 95%CI=1.003-1.100, p = 0.037). All-cause mortality did not differ between the two groups (30.2%vs. 29.9%, log-rank p = 0.983). However, among patients with elevated body temperature, an increase in body temperature, especially ≥1.1 °C, was associated with higher all-cause mortality (HR=1.968, 95%CI=1.096-3.535, p = 0.023). CONCLUSIONS: In CS patients requiring VA-ECMO, body temperature elevated in 58.9% patients after the removal of VA-ECMO. In those with elevated body temperature, a greater rise in body temperature was associated with higher mortality, suggesting body temperature as a potential signature to stratify risks of mortality in CS patients without any infectious signs.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
12,13-diHOME Is Increased During Targeted Temperature Management And Correlates With Survival After Cardiac Arrest Resuscitation.
Clinical takeaway These findings identify a survival-associated biomarker in post-arrest temperature management. They do not establish that brown adipose tissue activity mediates treatment benefit or that biomarker-guided temperature management improves outcomes.
Summary & abstract
Study summary
This observational study measured circulating 12,13-diHOME, a brown-adipose-tissue-associated lipid, in 74 patients from 6 hours through 7 days after return of spontaneous circulation. Levels were increased in patients receiving targeted temperature management at 33°C and were associated with survival. Concentrations peaked during the first 12–48 hours and fell below the initial post-resuscitation level by day 7. Higher levels were also associated with more mature and fewer immature neutrophils, while a subset of patients with higher levels showed a specific phospholipid signature.
Study limitation: The abstract provides no survival effect estimate, uncertainty interval, adjustment details, or survival assessment timepoint.
Published abstract
CONTEXT: Trials of targeted temperature management (TTM) after cardiac arrest (CA) have had conflicting results. Brown adipose tissue (BAT) is a thermogenic organ activated by cold temperature to regulate body temperature, systemic metabolism and the immune system. Approximately 10-30% of adult patients have BAT and this heterogeneity may explain variable treatment to TTM. OBJECTIVE: This study sought to measure differences in outcome, metabolic and immune activation between patients treated with TTM following CA with varying BAT activity, measured through BAT-associated lipid 12,13-diHOME concentrations in circulation. DESIGN: BAT biomarker 12,13-diHOME was quantified using liquid chromatography-mass spectrometry (LC-MS) on plasma from 74 patients at various time points starting at 6 hours and up until 7 days after return of spontaneous circulation (ROSC). Additionally, circulating glucose, C-peptide and fatty acids were measured by glucometer, ELISA and LC-MS, respectively. Peripheral blood mononuclear cells were analyzed by flow cytometry. RESULTS: 12,13-diHOME was increased in patients treated with TTM at 33°C and positively correlated with favorable outcomes. 12,13-diHOME levels peaked in the first 12 to 48 hours and decreased below the first post-ROSC level by 7 days. Glucose homeostasis was not associated with 12,13-diHOME levels. In a subset of patients, we could detect a specific phospholipid signature in patients with higher 12,13-diHOME. Patients with higher 12,13-diHOME also had increased mature neutrophils and lower immature neutrophils. CONCLUSIONS: Circulating 12,13-diHOME levels are increased in some patients undergoing targeted temperature management after cardiac arrest, which may be indicative of increased BAT activity. 12,13-diHOME is associated with survival, alterations of phospholipid metabolism, and a profile of less activated immune system. BAT may mediate the effects of temperature management on outcome after cardiac arrest.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Postoperative infections after cardiac surgery with cardiopulmonary bypass - incidence, performance of diagnostic procedures, and predictive factors.
Clinical takeaway Postoperative infection was associated with higher mortality after cardiac surgery with bypass. Common inflammatory markers showed poor diagnostic performance, limiting their usefulness for distinguishing infection from postoperative inflammation.
Summary & abstract
Study summary
This bidirectional cohort included 1,222 patients undergoing cardiac surgery with cardiopulmonary bypass; postoperative infections during hospitalisation and/or later occurred in 17.3%. Compared with uninfected patients, those with infection had higher 90-day mortality (3.8% versus 1.5%, p=0.045) and 1-year mortality (5.7% versus 2.7%, p=0.032). CRP, white blood cell count, and temperature performed poorly for infection detection, despite peak CRP and peak temperature being independent predictors. Peak temperature occurred on postoperative day 5 in infected patients versus day 2 in those without infection.
Study limitation: The observational comparison cannot establish causality; infected patients had more comorbidities and underwent more complex procedures.
Published abstract
OBJECTIVES: Cardiac surgery using cardiopulmonary bypass (CPB) induces a systemic inflammatory response that affects common inflammatory markers, including C-reactive protein (CRP), white blood cell count (WBC), and body temperature, complicating postoperative diagnosis of infections. The objective of this study was to assess the incidence of postoperative infections and evaluate the performance of clinically used biomarkers. DESIGN: This was a bidirectional cohort study including patients undergoing cardiac surgery with CPB between 1st of February 2020 and 22nd of September 2021. Patients with postoperative infection were compared to patients without. Multivariable logistic regression was used to identify independent predictors of postoperative infections. Receiver operating characteristic (ROC) curves evaluated the diagnostic ability of current biomarkers to detect infection. RESULTS: A total of 1,222 patients were included. The incidence of postoperative infections (during hospitalisation and/or late infection) was 17.3%. Patients with postoperative infection had more comorbidities, underwent more complex procedures, and had higher mortality (90-day mortality 3.8% vs 1.5%, p = 0.045; 1-year mortality 5.7% vs 2.7%, p = 0.032). CRP, WBC, and temperature performed poorly in detecting postoperative infection, although peak CRP (OR 1.069, p < 0.001) and peak temperature (OR 2.408, p = 0.005) were independent predictors of postoperative infection. Peak temperature occurred on postoperative day 5 in infected patients versus day 2 in those without infection. CONCLUSION: Postoperative infections following cardiac surgery with CPB remain common and are associated with increased postoperative complications and mortality. Common inflammatory biomarkers perform poorly in detecting infection. Improved diagnostic tools are needed to facilitate early detection and treatment.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Antithrombotic strategies and outcomes in acute myocardial infarction-related cardiogenic shock requiring short-term mechanical circulatory support.
Clinical takeaway This cohort highlights frequent early major bleeding alongside substantial mortality in infarct-related shock requiring mechanical support. It does not establish which antithrombotic strategy offers the best balance of bleeding and ischemic outcomes.
Summary & abstract
Study summary
This retrospective, single-center study included 71 patients with acute myocardial infarction-related cardiogenic shock receiving short-term mechanical circulatory support after PCI. In-hospital mortality was 56%, while the composite of ischemic events and all-cause mortality during shock occurred in 42%. Triple therapy use decreased from 79% at support initiation to 39% by day 7. Ischemic events occurred in 8%, with no recurrent myocardial infarction or stent thrombosis observed. Major bleeding occurred in 32%, typically within 48 hours, and was more frequent among patients receiving VA-ECMO.
Study limitation: The small, retrospective, single-center cohort and absence of reported adjusted regimen comparisons limit causal interpretation.
Published abstract
BACKGROUND: Cardiogenic shock following acute myocardial infarction (AMI-CS) is associated with high mortality. Short-term mechanical circulatory support (ST-MCS) is frequently used after percutaneous coronary intervention (PCI) to stabilize hemodynamics. However, balancing anticoagulation (AC) and antiplatelet therapy in this setting poses substantial bleeding risk. OBJECTIVES: This study aimed to evaluate real-world antithrombotic strategies and associated ischemic and hemorrhagic complications in AMI-CS patients receiving ST-MCS. METHODS: This retrospective, single-center study included all consecutive AMI-CS patients who underwent PCI and required ST-MCS between January 2017 and October 2024. AC and antiplatelet regimens were recorded from ST-MCS initiation until shock resolution. Ischemic and hemorrhagic events during this period were analyzed. The primary composite clinical endpoint was major adverse cardiovascular events (MACE), defined as a composite of ischemic events and all-cause mortality occurring during the period of cardiogenic shock. RESULTS: Among 71 patients with AMI-CS who underwent PCI and required ST-MCS (mean age 62 ± 13 years, 69% male), in-hospital mortality was 56%, and MACE occurred in 42%. At ST-MCS initiation, 79% received triple therapy, decreasing to 39% by Day 7. Ischemic events were infrequent (8%) and mainly cerebrovascular. No cases of recurrent myocardial infarction or stent thrombosis were observed. Major bleeding (BARC ≥ 3) occurred in 32% of patients, typically within the first 48 h, and was more frequent in those supported with VA-ECMO. CONCLUSION: In AMI-CS patients requiring ST-MCS, ischemic events were uncommon, whereas major bleeding was frequent and occurred early. These findings underscore the need for individualized antithrombotic strategies in this high-risk population.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Microcirculatory Hemodynamic Changes on Full Support Microaxial Flow Pump in Cardiogenic Shock.
Clinical takeaway Full-support microaxial pump use was associated with improved microcirculatory measures, particularly when baseline perfusion was impaired. These exploratory physiological findings do not establish a device-specific benefit.
Summary & abstract
Study summary
This prospective, single-arm observational study assessed serial sublingual microcirculation in 18 patients with cardiogenic shock undergoing Impella 5.5 placement. Immediately on support, microvascular flow index (p = 0.004) and proportion of perfused vessels (p = 0.003) improved, including after adjustment for vasoactive-inotropic score. Changes in microvascular heterogeneity index (p = 0.055) and perfused vessel density (p = 0.067) did not reach statistical significance. Improvements were greatest among patients with impaired baseline microcirculation; no systemic haemodynamic marker was sufficient to ensure adequate microcirculatory perfusion.
Study limitation: The small, single-arm study cannot separate device effects from overall clinical improvement, and its endpoints are physiological rather than patient-centred.
Published abstract
Impaired microcirculation predicts mortality in cardiogenic shock independent of systemic hemodynamics, yet current treatment strategies focus primarily on restoring macrocirculatory markers. We studied whether full-support microaxial flow pump (mAFP) therapy improves sublingual microcirculation in cardiogenic shock. A prospective, single-arm, observational study of serial sublingual microcirculation imaging via incident darkfield handheld videomicroscopy was performed in 18 cardiogenic shock patients undergoing Impella 5.5 (mAFP) placement. Microvascular flow index (MFI), microvascular heterogeneity index (MHI), proportion of perfused vessels (PPV), and perfused vessel density (PVD) were measured. Eighteen patients were enrolled. Microvascular flow index (p = 0.004), MHI (p = 0.055), PPV (p = 0.003), and PVD (p = 0.067) improved immediately on support, including when adjusted for vasoactive-inotropic score. Improvement in MFI, MHI, PPV, or PVD was most pronounced in those with impaired baseline microcirculatory hemodynamics (all p < 0.05), whereas those with preserved baseline values demonstrated no change. Improved agreement between systemic and microcirculatory hemodynamics was observed in association with mAFP support, and none experienced worsening microcirculatory function. These exploratory findings suggest full-support mAFPs may improve impaired microcirculation during cardiogenic shock, although device-specific effects cannot be isolated from overall clinical improvement; validation in larger studies is warranted. Although agreement between systemic and microcirculatory hemodynamic markers improved, no macrohemodynamic marker proved sufficient to ensure adequate microcirculatory perfusion.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.
Evaluation of Four-Factor Prothrombin Complex Concentrate Dosing for Major Bleeding Following Cardiac Surgery.
Clinical takeaway This small observational comparison does not establish equivalent effectiveness or safety between dosing strategies. The numerical thromboembolic difference is inconclusive and warrants further study.
Summary & abstract
Study summary
This retrospective review compared 4F-PCC at 25 versus 12.5 units/kg after a cardiac-surgery dosing protocol change, including 31 and 11 patients, respectively. The primary endpoint, receiving at least three packed red blood cell transfusions within 24 hours, occurred in 15 versus three patients (P = .299). Thromboembolic events within 14 days occurred in 22.6% versus 0%, respectively (P = .161), leaving considerable uncertainty about this numerical difference. No statistically significant differences were reported in additional haemostatic agent use, hospital length of stay or mortality.
Study limitation: The small, unequal groups and retrospective comparison following a protocol change limit precision and causal interpretation.
Published abstract
Four-factor prothrombin concentrate complex (4F-PCC) may be used for significant bleeding following cardiac surgery but the optimal dosing has not been established. The purpose of this study was to compare two dosing strategies of 4F-PCC in cardiac surgery patients. This retrospective chart review evaluated 4F-PCC dosing of 25 units/kg compared to 12.5 units/kg in cardiac surgery patients following a protocol change for 4F-PCC dosing. The primary outcome was major bleeding, defined as the number of patients receiving ≥3 packed red blood cell (PRBC) transfusions within 24 h of 4F-PCC administration. Secondary outcomes included other surrogate markers for bleeding (eg, Use of other blood products and hemostatic agents), thrombotic events within 14 days of surgery, hospital length of stay, and all-cause mortality. A total of 42 patients were included (31 patients in the 25 units/kg group and 11 patients in the 12.5 units/kg group). There was no difference in the number of patients that received ≥3 PRBC transfusions between the two groups with 15 patients (47.4%) in 25 units/kg group and 3 patients (27.3%) in 12.5 units/kg (P = .299). Additionally, no difference was observed in amount of additional hemostatic agents administered, hospital length of stay or mortality between the two groups. A higher rate of thromboembolic events was observed among patients receiving 25 units/kg vs 12.5 units/kg (22.6% vs 0%, P = .161). Reduced dosing of 4F-PCC from 25 units/kg to 12.5 units/kg following cardiac surgery resulted in no difference in clinical or effectiveness outcomes.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.