1
|
Ott S, Lee ZY, Müller-Wirtz LM, Cangut B, Roessler J, Patterson W, Thomas CM, Bekele BM, Windpassinger M, Lobdell K, Grant MC, Arora RC, Engelman DT, Fremes S, Velten M, O'Brien B, Ruetzler K, Heyland DK, Stoppe C. The effect of a selenium-based anti-inflammatory strategy on postoperative functional recovery in high-risk cardiac surgery patients - A nested sub-study of the sustain CSX trial. Life Sci 2024; 351:122841. [PMID: 38897349 DOI: 10.1016/j.lfs.2024.122841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
AIM The cardiac surgery-related ischemia-reperfusion-related oxidative stress triggers the release of cytotoxic reactive oxygen and nitrogen species, contributing to organ failure and ultimately influencing patients' short- and long-term outcomes. Selenium is an essential co-factor for various antioxidant enzymes, thereby contributing to the patients' endogenous antioxidant and anti-inflammatory defense mechanisms. Given these selenium's pleiotropic functions, we investigated the effect of a high-dose selenium-based anti-inflammatory perioperative strategy on functional recovery after cardiac surgery. MATERIALS AND METHODS This prospective study constituted a nested sub-study of the SUSTAIN CSX trial, a double-blinded, randomized, placebo-controlled multicenter trial to investigate the impact of high-dose selenium supplementation on high-risk cardiac surgery patients' postoperative recovery. Functional recovery was assessed by 6-min walk distance, Short Form-36 (SF-36) and Barthel Index questionnaires. KEY FINDINGS 174 patients were included in this sub-study. The mean age (SD) was 67.3 (8.9) years, and 78.7 % of the patients were male. The mean (SD) predicted 30-day mortality by the European System for Cardiac Operative Risk Evaluation II score was 12.6 % (9.4 %). There was no difference at hospital discharge and after three months in the 6-min walk distance between the selenium and placebo groups (131 m [IQR: not performed - 269] vs. 160 m [IQR: not performed - 252], p = 0.80 and 400 m [IQR: 299-461] vs. 375 m [IQR: 65-441], p = 0.48). The SF-36 and Barthel Index assessments also revealed no clinically meaningful differences between the selenium and placebo groups. SIGNIFICANCE A perioperative anti-inflammatory strategy with high-dose selenium supplementation did not improve functional recovery in high-risk cardiac surgery patients.
Collapse
Affiliation(s)
- Sascha Ott
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Zheng-Yii Lee
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Lukas M Müller-Wirtz
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center and Saarland University Faculty of Medicine, 66424 Homburg, Saarland, Germany; Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA.
| | - Busra Cangut
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Julian Roessler
- Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Institute of Anaesthesiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - William Patterson
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, OH, USA.
| | - Christian M Thomas
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany.
| | - Biniam M Bekele
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marita Windpassinger
- Department of Anesthesia, Critical Care and Pain Medicine, Division of General Anesthesia and Intensive Care Medicine, Medical University Vienna, Vienna, Austria.
| | - Kevin Lobdell
- Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC 28203, USA.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA; Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Rakesh C Arora
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health and University of Massachusetts Chan Medical School-Baystate, 759 Chestnut Street, Springfield, MA 01199, USA
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Department of Surgery, University of Toronto, Toronto, Canada.
| | - Markus Velten
- Department of Anesthesiology and Pain Management, Division of Cardiovascular and Thoracic Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Benjamin O'Brien
- Deutsches Herzzentrum der Charité, Department of Cardiac Anaesthesiology and Intensive Care Medicine, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; St Bartholomew's Hospital and Barts Heart Centre, Department of Perioperative Medicine, London EC1A 7BE, UK.
| | - Kurt Ruetzler
- Outcomes Research Consortium, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany; Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany.
| |
Collapse
|
2
|
Aboobacker Kaniyamparambil R, Goldsmith C, Demasi N, Wibrow B, ParangiAnanthan P, Regli A, Anstey M, Pellicano S, Palermo AM, Van Der Laan S, Litton E. Health concerns of intensive care survivors and research participation willingness: A multicentre survey. CRIT CARE RESUSC 2024; 26:95-99. [PMID: 39072234 PMCID: PMC11282345 DOI: 10.1016/j.ccrj.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 07/30/2024]
Abstract
Objective To describe the relative importance of health concerns reported by survivors of critical illness treated in the intensive care unit (ICU), their estimate of time to achieve recovery, and their reported randomised clinical trial participation willingness. Design A multicentre survey. Setting Six Australian ICUs. Participants Adult patients who had received mechanical ventilation, vasopressor support or renal replacement therapy for more than 24 h were likely to be discharged from ICU within 24 h. Interventions Survey administration was verbal and occurred in the ICU. Main outcome measures A numeric rating of eight ICU survivor-related health concerns developed with consumer input (disability requiring ongoing care, prolonged hospitalisation, repeated hospitalisation, impaired activity level, pain, low mood, inability to return home, and dying). Zero indicated no concern and ten extreme concern. Respondents were also asked to estimate their expected recovery time and their willingness to participate in a randomised clinical trial. Results Of 584 eligible participants, 286 (49.0%) respondents had a mean age of 62.3 years (standard deviation (SD) 14.8) and 178 (62.2%) were male. The median ICU length of stay at the time of survey was 4 days (interquartile range (IQR) 3-7). Respondents reported high levels of concern for all health outcomes with the highest median scores being for survival with severe disability and requirement for ongoing care scoring 8 (IQR 3-10), and never being able to return home needing assisted living or a nursing home scoring 8 (IQR 1-10). The median expected recovery time was 23 days (IQR 10-33). Higher concerns were associated with an increased likelihood of trial participation willingness. Conclusion Survivors reported high and varied health concerns of which severe disability requiring care and inability to return home were the highest. Respondents anticipated a relatively short recovery.
Collapse
Affiliation(s)
| | | | | | - Brad Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth 6009, WA, Australia
| | | | - Adrian Regli
- St John of God Hospital Murdoch, Perth 6150, WA, Australia
| | - Matt Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth 6009, WA, Australia
| | - Susan Pellicano
- Intensive Care Unit, Fiona Stanley Hospital, Perth 6150, WA, Australia
| | | | | | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth 6150, WA, Australia
- School of Medicine, University of Western Australia, 6009, WA, Australia
| |
Collapse
|
3
|
Auriemma CL, Butt MI, Bahti M, Silvestri JA, Solomon E, Harhay MO, Klaiman T, Schapira MM, Barg FK, Halpern SD. Measuring Quality-weighted Hospital-Free Days in Acute Respiratory Failure: A Modified Delphi Study. Ann Am Thorac Soc 2024; 21:928-939. [PMID: 38507646 PMCID: PMC11160130 DOI: 10.1513/annalsats.202311-962oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024] Open
Abstract
Rationale: Hospital-free days (HFDs), a measure of the number of days alive spent outside the hospital, is increasingly used as an endpoint in studies of patients with acute respiratory failure (ARF) or other critical and serious illnesses. Current approaches to measuring HFDs do not account for decrements in functional status or quality of life that ARF survivors and family members value. Objectives: To develop an acceptable approach to measure quality-weighted HFDs using patient-reported outcomes. Methods: We conducted a four-round modified Delphi process among ARF experts: those with lived or professional experience. Experts rated survivorship domains, instrument and data collection characteristics, and methods to translate responses into quality-weighted HFDs. The consensus threshold was that ⩾70% of respondents rated an item "totally acceptable" or "acceptable" and ⩽15% of respondents rated the item "totally unacceptable," "unacceptable," or "slightly unacceptable." Results: Fifty-seven experts participated in round 1. Response rates were 82-93% for subsequent rounds. Priority survivorship domains were physical function and health-related quality of life. Participants reached a consensus that data collection during ARF recovery should take less than 15 minutes per assessment, allow surrogate completion when patients are unable, and continue for at least 24 months of follow-up. Using the EuroQol-5 Dimensions (EQ-5D) questionnaire to quality weight HFDs met consensus criteria for acceptability. A majority of panelists preferred quality-weighted HFDs to unweighted HFDs or survival for use in future ARF studies. Conclusions: Quality-weighting HFDs using patient and/or surrogate responses to the EQ-5D captured stakeholder priorities and was acceptable to this Delphi panel.
Collapse
Affiliation(s)
- Catherine L. Auriemma
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
| | | | | | | | | | - Michael O. Harhay
- Palliative and Advanced Illness Research Center
- Department of Biostatistics, Epidemiology, and Informatics
| | | | - Marilyn M. Schapira
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Center for Health Equity Research & Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Frances K. Barg
- Department of Family Medicine and Community Health, and
- Department of Anthropology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Scott D. Halpern
- Palliative and Advanced Illness Research Center
- Department of Medicine
- Leonard Davis Institute of Health Economics
- Department of Biostatistics, Epidemiology, and Informatics
| |
Collapse
|
4
|
Fernando SM, Qureshi D, Talarico R, Vigod SN, McIsaac DI, Sterling LH, van Diepen S, Price S, Di Santo P, Kyeremanteng K, Fan E, Needham DM, Brodie D, Bienvenu OJ, Combes A, Slutsky AS, Scales DC, Herridge MS, Thiele H, Hibbert B, Tanuseputro P, Mathew R. Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study. Intensive Care Med 2024; 50:901-912. [PMID: 38695924 DOI: 10.1007/s00134-024-07399-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/21/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. METHODS We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. RESULTS We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767 days (interquartile range (IQR) 225-1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4-113.9), compared with 103.8 per 1000 person-years (95% CI 102.5-105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94-1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. CONCLUSION Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.
Collapse
Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada.
| | - Danial Qureshi
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
| | - Simone N Vigod
- ICES, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Women's College Hospital and Research Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lee H Sterling
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
| | - Susanna Price
- Royal, Brompton & Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Pietro Di Santo
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Eddy Fan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oscar Joseph Bienvenu
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France
- Service de Médeceine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Margaret S Herridge
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Mathew
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| |
Collapse
|
5
|
Tran A, Rochwerg B, Fan E, Belohlavek J, Suverein MM, Poll MCGVD, Lorusso R, Price S, Yannopoulos D, MacLaren G, Ramanathan K, Ling RR, Thiara S, Tonna JE, Shekar K, Hodgson CL, Scales DC, Sandroni C, Nolan JP, Slutsky AS, Combes A, Brodie D, Fernando SM. Prognostic factors associated with favourable functional outcome among adult patients requiring extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2023; 193:110004. [PMID: 37863420 DOI: 10.1016/j.resuscitation.2023.110004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established. METHODS We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach. FINDINGS We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes). INTERPRETATION The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered - that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk stratification framework when evaluating a patient's potential candidacy for ECPR.
Collapse
Affiliation(s)
- Alexandre Tran
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jan Belohlavek
- 2(nd) Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic; First Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Martje M Suverein
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Susanna Price
- Royal Brompton & Harefield Hospitals, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Demetris Yannopoulos
- Division of Cardiology and Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sonny Thiara
- Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Joseph E Tonna
- Departments of Emergency Medicine and Cardiothoracic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane and Bond University, Gold Coast, Queensland, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, Australia
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Claudio Sandroni
- Institute of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Intensive Care, Emergency Medicine and Anesthesiology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Alain Combes
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Paris, France; Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
| |
Collapse
|
6
|
Eaton TL, Taylor SP. Health system approaches to providing posthospital care for survivors of sepsis and critical illness. Curr Opin Crit Care 2023; 29:513-518. [PMID: 37641522 DOI: 10.1097/mcc.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW In the current review, we highlight developing strategies taken by healthcare systems to improve posthospital outcomes for sepsis and critical illness. RECENT FINDINGS Multiple studies conducted in the adult population over the last 18 months have advanced current knowledge on postdischarge care after sepsis and critical illness. Effective interventions are complex and multicomponent, targeting the multilevel challenges that survivors face. Health systems can leverage existing care models such as primary care or invest in specialty programs to deliver postdischarge care. Qualitative and implementation science studies provide insights into important contextual factors for program success. Several studies demonstrate successful application of telehealth to improve reach of postdischarge support. Research is beginning to identify subtypes of survivors that may respond to tailored intervention strategies. SUMMARY Several successful critical illness survivor models of care have been implemented and knowledge about effectiveness, cost, and implementation factors of these strategies is growing. Further innovation is needed in intervention development and evaluation to advance the field.
Collapse
Affiliation(s)
- Tammy L Eaton
- National Clinician Scholars Program (NCSP); VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan Department of Systems, Populations and Leadership, University of Michigan School of Nursing
| | - Stephanie Parks Taylor
- Division of Hospital Medicine, Michigan Medicine; & Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Sterling LH, Fernando SM, Talarico R, Qureshi D, van Diepen S, Herridge MS, Price S, Brodie D, Fan E, Di Santo P, Jung RG, Parlow S, Basir MB, Scales DC, Combes A, Mathew R, Thiele H, Tanuseputro P, Hibbert B. Long-Term Outcomes of Cardiogenic Shock Complicating Myocardial Infarction. J Am Coll Cardiol 2023; 82:985-995. [PMID: 37648357 DOI: 10.1016/j.jacc.2023.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends. OBJECTIVES This study sought to examine long-term outcomes of AMI-CS patients. METHODS This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019. Outcome data were captured using linked health administrative databases. RESULTS A total of 9,789 consecutive patients with AMI-CS from 135 centers were included. The mean age was 70.5 ± 12.3 years, and 67.7% were male. The incidence of AMI-CS was 8.2 per 100,000 person-years, and it increased over the study period. Critical care interventions were common, with 5,422 (55.4%) undergoing invasive mechanical ventilation, 1,425 (14.6%) undergoing renal replacement therapy, and 1,484 (15.2%) receiving mechanical circulatory support. A total of 2,961 patients (30.2%) died in the hospital, and 4,004 (40.9%) died by 1 year. Mortality at 5 years was 58.9%. Small improvements in short- and long-term mortality were seen over the study period. Among survivors to discharge, 2,870 (42.0%) required increased support in care from their preadmission baseline, 3,244 (47.5%) were readmitted to the hospital within 1 year, and 1,047 (15.3%) died within 1 year. The mean number of days at home in the year following discharge was 307.9 ± 109.6. CONCLUSIONS Short- and long-term mortality among patients with AMI-CS is high, with minimal improvement over time. AMI-CS survivors experience significant morbidity, with high risks of readmission and death. Future studies should evaluate interventions to minimize postdischarge morbidity and mortality among AMI-CS survivors.
Collapse
Affiliation(s)
- Lee H Sterling
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Robert Talarico
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susanna Price
- Royal Brompton & Harefield Hospitals, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Damon C Scales
- ICES, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne University, Paris, France; Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Toronto, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
8
|
Herbst N, Javidfar J. The Burden of Survivorship After Venoarterial Extracorporeal Membrane Oxygenation: A Black Box. Crit Care Med 2023; 51:1278-1280. [PMID: 37589522 DOI: 10.1097/ccm.0000000000005948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Nicole Herbst
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Jeffrey Javidfar
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, GA
| |
Collapse
|