Elena Dolmatova

Extracorporeal Membrane Oxygenation in Massive Pulmonary Embolism.

Background Extracorporeal Membrane Oxygenation (ECMO) has been suggested for cardiopulmonary support in patients with massive pulmonary embolism (PE) refractory to other treatment or as bridging to embolectomy. The survival benefit from ECMO in patients with massive PE remains unclear. Methods Here, we describe 5 cases in which ECMO was used as cardiopulmonary support following massive near‐fatal pulmonary embolism. Results The overall mortality in patients with massive PE that received ECMO support was 40%. Death occurred secondary to ECMO‐related complication in one case and due to inability to maintain adequate cerebral perfusion despite ECMO support in the second case. Conclusions ECMO can be considered as a treatment modality for patients with massive PE.

In-Hospital Outcomes and Complications of Coronary Artery Bypass Grafting in the United States Between 2008 and 2012

OBJECTIVE To investigate the frequency and predictors of in-hospital complications among patients undergoing coronary artery bypass grafting (CABG) in the United States. DESIGN Retrospective national database analysis SETTINGS: United States hospitals. PARTICIPANTS A weighted sample of 1,910,236 patients undergoing CABG surgery identified from the National (Nationwide) Inpatient Sample from 2008 to 2012. INTERVENTIONS CABG surgery MEASUREMENTS AND MAIN RESULTS: The number of CABG surgeries decreased from 436,275 in 2008 to 339,749 in 2012. The Deyo comorbidity index showed a steady increase from 2008 to 2012. The rate of in-hospital mortality decreased from 2.7% in 2008 to 2.2% in 2012 (p<0.001). The most common in-hospital complication was postoperative hemorrhage (30.4%), followed by cardiac (11.34%) and respiratory complications (2.3%). During the 5-year period, the rates of in-hospital cardiac, respiratory and infectious complications decreased (p<0.001), while the rate of postoperative hemorrhage showed a 35.8% relative increase in 2012 compared to 2008. CONCLUSION The annual number of CABG surgeries is declining in the United States. While the burden of comorbidities is increasing, the rates of mortality and most in-hospital complications are improving. The increasing rate of postoperative bleeding necessitates the need to develop strategies to improve the risk of bleeding in this patient population.

Extracorporeal membrane oxygenation in transcatheter aortic valve replacement.

Background Patients undergoing transcatheter aortic valve replacement can experience severe perioperative complications leading to hemodynamic instability and death. Venoarterial extracorporeal membrane oxygenation can be used to provide cardiorespiratory support during this time. Methods From 2012 to 2015, of 247 patients who underwent transcatheter aortic valve replacement, 6 (2.42%) required extracorporeal membrane oxygenation support. Their mean age was 82 ± 7.4 years, mean Society of Thoracic Surgeons score was 9.4 ± 6.6, and mean aortic gradient was 28.3 ± 12 mm Hg. Rescue extracorporeal membrane oxygenation was required for hemodynamic instability due to ventricular fibrillation (n = 1), respiratory failure (n = 1), left ventricular wall rupture (n = 2), and aortic annulus rupture (n = 1). In one patient, prophylactic extracorporeal membrane oxygenation was required due to advanced heart failure. Additional procedures included valve-in-valve implantation (n = 1), conversion to an open procedure (n = 3), and intraaortic balloon pump insertion (n = 1). Results The median hospital stay was 20 days. There were 2 hospital deaths in patients whose hospital course was complicated by left ventricular wall rupture or aortic annulus rupture with resulting tamponade. Among the 4 survivors, one required continuous ventilator support following discharge, and 3 experienced no major complications during the first month after discharge. Conclusions Extracorporeal membrane oxygenation can be considered a viable option for high-risk patients undergoing transcatheter aortic valve replacement and those who develop cardiac complications following this procedure and require cardiorespiratory support.

Suicidal ideation among adults with cardiovascular disease: The National Health and Nutrition Examination Survey

OBJECTIVE Previous studies have shown a possible link between cardiovascular disease (CVD) and suicidal ideation (SI). However, limited information exists regarding the association between different subtypes of CVD and SI and the role of depression. METHODS Data were used from the National Health and Nutrition Examination Survey for cycles 2009-2010 and 2011-2012. SI was assessed by item 9 of the Patient Health Questionnaire 9. Data regarding sociodemographic factors, and comorbid conditions were collected and examined as potential correlates. Logistic regression analyses were used to examine the relationship between CVD and subtypes and suicidal ideation. RESULTS Among a total of 11,678 participants, suicidal ideation was significantly higher among patients with CVD compared to participants without a history of CVD (5.4% vs 3.6%, P<0.001). A subset of patients with CVD with a history of congestive heart failure (CHF) and prior myocardial infarction (MI) had the highest percentage of SI (10.6%). The association between CVD and SI remained significant after adjusting for baseline characteristics and associated comorbidities including depression (OR 1.40, 95% CI 1.10-2.09, P=0.006). CONCLUSION CVD is an independent risk factor for SI. The identification of a subset of patients with CVD at greatest risk of SI underlines the importance of screening in this vulnerable population.

TRENDS IN UTILIZATION OF INPATIENT PALLIATIVE CARE SERVICES AND RACIAL DISPARITY OF DISPOSITION TO HOSPICE CARE AMONG PATIENTS WITH HEART FAILURE IN THE UNITED STATES BETWEEN 2003 AND 2012

Background: The latest American Heart Association guidelines have recommended palliative/hospice care in selected patients with end-stage heart failure (HF). However, limited information exists regarding the trends in utilization of hospice care in this patient population. Methods: Data from the

PREDICTORS OF CARDIAC TAMPONADE FROM PERMANENT PACEMAKER IMPLANTATION: ANALYSIS OF 1,014,713 PROCEDURES

Cardiac tamponade is a relatively uncommon complication following Permanent Pacemaker (PPM) implantation. Therefore, limited data exists regarding the predictors of tamponade among recipients of this procedure. We sought to identify predictors of cardiac tamponade from PPM implantation and