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Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial.
BackgroundCardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate. Cardiogenicshock after outofhospital cardiacarrest (OHCA) can be due to transient myocardial stunning but also reflect the increasing severity of ongoing heart failure. Of 789 patients included, 31.6%
Introduction The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a treatment option for selected patients who are experiencing refractory cardiacarrest (CA).
Lactate was 20, POC Cardiac US showed EF estimated at 30%, and formal echo showed EF of only 15%, and a normal RV. Assessment was severe sudden cardiogenicshock. and the patient was converted to veno-venous (V-V) ECMO due to persistent pulmonary insufficiency. Clinically — the patient was felt to be in cardiogenicshock.
Smith comment: before reading anything else, this case screamed pulmonary embolism to me. I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. There is sinus tachycardia at ~100/minute.
BACKGROUND:There are limited large-scale data on the outcomes of patients with cardiogenicshock (CS) transferred to hub centers. During the hospitalization, they had higher rates of renal failure, pulmonary artery catheter use, and mechanical circulatory support use. Circulation: Heart Failure, Ahead of Print.
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