Comparison of PLANE Technique versus Standard Echocardiography Guidance for Pediatric Pericardiocentesis

2021 ◽  
Author(s):  
Stephen T. Clark ◽  
Jeffrey A. Alten ◽  
Santiago Borasino ◽  
Kristal M. Hock ◽  
Mark A. Law
Keyword(s):  
High Risk ◽  
High Risk Patient ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Entire Cohort ◽  
Catheterization Laboratory ◽  
Technical Success Rate ◽  
Cardiac Catheterization Laboratory ◽  
Plane Technique ◽  
Guidance Technique

AbstractPercutaneous pericardiocentesis remains a challenging and potentially dangerous procedure, particularly in small, critically ill patients. We present outcomes of the PLANE (pericardiocentesis using long-axis in-plane real-time echocardiography) technique for pediatric pericardiocentesis compared with a standard echocardiography (ECHO) guidance cohort. This was a retrospective chart review of all children undergoing percutaneous pericardiocentesis from March 2013 to February 2021 at a single center. A total of 78 procedures were performed, 52 utilizing PLANE technique and 26 utilizing standard ECHO-guidance technique. There was 100% technical success rate with only one minor complication for the entire cohort. Procedures were evenly split between the bedside intensive care unit and cardiac catheterization laboratory. PLANE technique was utilized in significantly younger (1.4 vs. 8.4 years, p = 0.008) and smaller (11.1 vs. 31.8 kg, p = 0.007) patients, as well as in most patients deemed high risk (postoperative < 7 days, extracorporeal membrane oxygenation (ECMO) support, and/or weight less than 5 kg; 19/22, p = 0.021). Other patient characteristics were similar between the two groups. There was a trend toward PLANE technique utilization by noncardiology trained operators. The PLANE technique for pediatric pericardiocentesis is safe and effective and can be effectively utilized in small and high-risk patient populations. The technical similarity to other long-axis ultrasound-guided procedures may facilitate adoption and mastery by critical care trained operators.

Abstract 12134: Risk of In-Hospital Deterioration for Children With Single Ventricle Physiology

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Henry Foote ◽  
Zohaib Shaikh ◽  
William Ratliff ◽  
Michael Gao ◽  
Bradley Hintze ◽  
...  
Keyword(s):  
High Risk ◽  
Pediatric Cardiology ◽  
Single Ventricle ◽  
Retrospective Chart Review ◽  
Clinical Deterioration ◽  
Inpatient Service ◽  
Lower Systolic Blood Pressure ◽  
Single Ventricle Physiology ◽  
Entire Cohort ◽  
Increased Risk

Introduction: Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality, with much of that increased risk coming in the first year of life. Understanding which children are at the highest risk for clinical deterioration may allow for increased monitoring and earlier escalation of care, with associated decreased mortality. Methods: We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU inpatient service from 2014 - 2018 for children < 18 years old. Clinical deterioration was defined as an unplanned transfer to the ICU or inpatient mortality. Children with SV were selected by diagnosis codes. Results: From the entire cohort of 1612 pediatric cardiology admissions (56 % male, 25% SV), 288 admissions had a deterioration event including 26 deaths. Infants less than one year with SV (n = 197 admissions) were significantly more likely to have a deterioration event (107 events over 62 admissions with an event) than the overall pediatric cardiology cohort (OR 2.11, 95% CI 1.52-2.93). Among infants with SV, those with a deterioration event were significantly younger (median 1.7 v 4.3 months, p < 0.001). Further, at baseline they had significantly lower oxygen saturation (84% v 87%, p < 0.01), lower systolic blood pressure (85mmHg v 90mmHg, p< 0.02), higher respiration rate (48 v 44, p < 0.01), and higher hematocrit (44.0 v 40.2, p < 0.005) compared to those who remained stable. Mean Pediatric Early Warning Scores (PEWS) were significantly higher for infants with SV who had a deterioration event (1.4 v 0.9, p < 0.001) and PEWS scores significantly increased in the 48 hours prior to an event (p < 0.001). Of the 104 non-death events, 61 required an increase in oxygen support and 51 required a fluid bolus prior to the event (p < 0.001). Conclusions: Infants with SV are at high risk for clinical deterioration. There are baseline differences in vital signs and lab work between those that remain stable and those that have a deterioration event. PEWS scores and oxygen and fluid treatment significantly increase prior to deterioration events. Leveraging data from the Electronic Medical Record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

Outcomes in AML patients receiving HMA + venetoclax combination with prior HMA exposure.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19011-e19011
Author(s):  
Bakos Keegan Jonathan ◽  
Dena Blanding ◽  
Christopher Andrew Rangel ◽  
Sarah Pasyar ◽  
Elizabeth Goodwin Hill ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tp53 Mutation ◽  
Clinical Laboratory ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Poor Response ◽  
Patient Characteristics ◽  
Entire Cohort ◽  
Kaplan Meier ◽  
Poor Outcomes

e19011 Background: Venetoclax (Ven) is a BCL-2 inhibitor approved in combination with hypomethylating agents (HMAs) in newly diagnosed AML patients who are not candidates for intensive induction based on impressive response rates (CR+CRi of 66.4%) and median overall survival (14.7 months) compared to HMA therapy alone (DiNardo CD, NEJM, 2020). Ven was also used in combination with 10 days of a HMA (Decitabine) in a phase II study. In the subgroup of patients with relapsed AML, some of which previously received HMA, the ORR, CR+CRi, and median OS were 62%, 42%, and 7.8 months respectively. (DiNardo CD, Lancet, 2020). To our knowledge there are no studies specifically looking at patients with AML receiving HMA + Ven with previous exposure to a HMA agent. Methods: We conducted a single center retrospective study of AML patients who received HMA + Ven therapy after previously receiving a HMA agent. Baseline demographic, clinical, laboratory, pathology, and outcomes data were collected by retrospective chart review. Response criteria was determined by 2017 ELN recommendations. Kaplan Meier was constructed to summarize time to event data. Results: A total of 17 patients were identified that met these criteria. 7 patients (41%) had progressed on prior HMA treatment, 11 patients (65%) received prior intensive chemotherapy, and 5 patients (29%) received previous Allogenic SCT prior to HMA+Ven therapy. 10 patients (59%) had either a TP53 mutation or 17p deletion and 11 patients (65%) had complex cytogenetics (≥ 3 cytogenetic abnormalities). Other patient characteristics are included in table below. For the entire cohort, the ORR (CR, CRi, PR) was 41% and the CR/CRi rate was 6%; The ORR in the following subgroups for previous HMA failure, TP53 mutation/17p deletion, and complex cytogenetics were 14%, 30%, and 36% respectively. The median Progression free survival and overall survival for the entire cohort was 2 months (1-4 months 95% CI) and 3 months (1-5 months, 95% CI) respectively. 15 patients (88%) were deceased and all deaths were attributed to AML (12/15) or infection (3/15). None of the patients went on to receive an Allogenic SCT. Conclusions: Although a limited sample size which includes many patients with a TP53/17p aberration, complex cytogenetics, Allogenic SCT relapse, and/or heavily pre-treated AML, this data describes poor outcomes in patients receiving HMA+Ven after previous HMA exposure. Patients with previous HMA failure in particular had a poor response rate. None of the patients received 10 day decitabine and it is unclear if this had any effect on the results. It would be beneficial to supplement this data with experience from multiple centers. Patient Characteristics (N = 17).[Table: see text]

Surgical and immunohistochemical (IC) risk factors for metastatic disease in stage IB1 cervical cancer (CC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16578-e16578 ◽  
Author(s):  
J. De La Mota ◽  
B. Thomas ◽  
W. Fengwei ◽  
B. Micaily ◽  
H. Yajue ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Metastatic Disease ◽  
High Risk Patient ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Adjuvant Radiation ◽  
Tumor Diameter ◽  
Ki 67 ◽  
Parametrial Involvement

e16578 Background: Stage IB1 CC is treated with radical abdominal hysterectomy (RH) and pelvic lymph node dissection (LND) because of presumed risk of parametrial and nodal involvement. We sought to identify surgical and IC risk factors for metastatic disease. Methods: Retrospective chart review of all stage IB1 CC patients who underwent RH and LND from 1996–2008. Results: Of the 35 patients identified, 25 (71%) had squamous cell, 9 (26%) adenocarcinoma, and 1 (3%) adenosquamous histology. Median tumor diameter of patients without lymphovascular space involvement (LVI), with LVI, and with positive LN was 1.2, 2.0, and 2.5 cm respectively. Median of 24 LNs was removed. LVI was noted in 13 (37%) patients of whom 5 (38%) had positive LN. None of the 22 patients without LVI had LN involvement. Only 2 of 35 (6%) had parametrial involvement, both of which had positive LN. All patients with positive LN received chemo-radiation. In addition six patients with LVI and deep cervical stromal invasion received adjuvant radiation therapy. Median follow-up was 14 months. Postoperatively 8 (23%) and 4 (11%) patients had early and late complications respectively. There was one (3%) vaginal recurrence in a patient with positive LN. The 5-year progression-free survival and overall survival was 95% and 100%, respectively. Immunohistochemical (IC) staining was performed on 29 cases (10 LVI, 4 positive LN) for bcl-2, p53, Ki-67. There was increased staining for Ki-67 in patients with LVI (61% vs. 44%, p = 0.01), and in those with positive LN (66% vs. 48%, p = 0.04). No correlation was found with p53 or Bcl-2. Conclusions: The rate of LN metastasis in patients with stage IB1 CC is significant (14 %), as is the rate of parametrial involvement (6%). However, it occurred only in patients with LVI. Staining for Ki-67 may help detect high-risk patient. RH followed by adjuvant therapy in high-risk patients resulted in 100% 5-year survival, but is associated with morbidity. No significant financial relationships to disclose.

Abstract 10476: Patient Characteristics and Survival Outcomes of Cardiac Arrest in the Cardiac Catheterization Laboratory: Insights from Get with the Guidelines-Resuscitation Registry

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ahmed Elkaryoni ◽  
John J Lopez ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Catheterization ◽  
Odds Ratio ◽  
American Heart ◽  
Patient Characteristics ◽  
Lower Survival Rate ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: The characteristics and outcomes of in-hospital cardiac arrest (IHCA) in the cardiac catheterization laboratory (CCL) have not been well-described. We compared the characteristics and outcomes of patients with an IHCA in the CCL versus those in the operating room (OR) and the intensive care unit (ICU). Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation® registry, we identified patients 18 years of age or older with an IHCA in the CCL, OR, or ICU between 2000 and 2019. We compared rates of survival to discharge for patients in the CCL, OR, and ICU. Additionally, we examined predictors of survival to discharge for patients with IHCA in the CCL. Results: There were 6866, 5181, and 181,832 patients with an IHCA in the CCL, OR, and ICU, respectively. Patients with IHCAs in the CCL were more likely to have a shockable cardiac arrest rhythm as compared with those in the OR and ICU. Overall, 2614 (38.1%) patients with IHCA in the CCL survived to discharge, as compared with 30,833 (16.9%) from the ICU and 2096 (40.5%) from the OR. After adjustment for 27 patient and cardiac arrest factors, patients with IHCA in CCL were more likely to survive to discharge as compared with those with IHCA from the ICU (odds ratio, 1.37 [95% CI: 1.29-1.46], p<0.001). In contrast, they were less likely to survive to discharge as compared with those with IHCA in the OR (odds ratio, 0.81 [95% CI: 0.69-0.94], p=0.006). Predictors of survival to discharge in patients with IHCA in the CCL included white race, pulseless ventricular tachycardia/fibrillation, and IHCA during normal hours and on weekdays, while having myocardial infarction during this or prior hospitalization was associated with less survival to discharge. (Table). Conclusion: IHCA in the CCL is not uncommon and has a lower survival rate as compared with IHCA in other procedural areas such as the OR. The reasons for this difference deserve further study given that response to IHCAs in both settings should be similar.

scholarly journals Pharmacist-Led Provider Education on Inappropriate NSAID Prescribing Rates

2020 ◽  
Vol 52 (8) ◽  
pp. 592-596
Author(s):  
Jangus B. Whitner ◽  
Nicole A. Fabiili ◽  
Jordan Siewart ◽  
Karen Akasaka ◽  
Anna Nelson
Keyword(s):  
High Risk ◽  
Family Medicine ◽  
Inappropriate Prescribing ◽  
High Risk Patient ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Provider Education ◽  
The Impact

Background and Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used pain medications among US adults with about 70 million people regularly taking NSAIDs annually. Despite clear recommendations from current clinical practice guidelines and recent supporting literature, NSAIDs are continually prescribed inappropriately in patients with chronic kidney disease (CKD), hypertension (HTN), and heart failure (HF). The purpose of this project was to determine the impact of direct pharmacist-led education to providers on rates of inappropriate prescribing of NSAIDs in high-risk populations in a family medicine setting. Methods: This study included all adult (aged 18 years or older) patient charts with NSAIDs prescribed, refilled, or recorded within the specified time periods. We defined inappropriate orders as oral and of chronic duration (at least 90 days) with at least one high-risk International Classification of Diseases-10 chart diagnosis (HTN, HF, CKD). This was a single-center, retrospective chart review of prescribing rates during a 3-month period before and after provider education delivered by a pharmacist. Results: We identified a total of 325 charts from preintervention and 489 charts postintervention that met inclusion criteria. Of those, the charts with orders categorized as inappropriate were 90 versus 44, respectively. The rate of inappropriate prescribing of NSAIDs significantly decreased from 27.7% to 9.0% (P&lt;.0001) postintervention. Among chronic NSAID users, both serum creatinine and systolic blood pressure significantly increased following NSAID initiation. Conclusions: A single pharmacist-led education intervention to primary care providers on inappropriate NSAID use in high-risk patient populations had a significant impact on minimizing inappropriate NSAID prescribing patterns within a family medicine outpatient office.

scholarly journals Prognostic Factors for Overall Survival In Chronic Myeloid Leukemia Patients: A Multicentric Cohort Study by the Italian CML GIMEMA Network

2021 ◽  
Vol 11 ◽  
Author(s):  
Giorgina Specchia ◽  
Patrizia Pregno ◽  
Massimo Breccia ◽  
Fausto Castagnetti ◽  
Chiara Monagheddu ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Kinase Inhibitors ◽  
Patient Characteristics ◽  
Entire Cohort ◽  
Increased Risk ◽  
Discriminant Ability ◽  
Sokal Score ◽  
Related Mortality

An observational prospective study was conducted by the CML Italian network to analyze the role of baseline patient characteristics and first line treatments on overall survival and CML-related mortality in 1206 newly diagnosed CML patients, 608 treated with imatinib (IMA) and 598 with 2nd generation tyrosine kinase inhibitors (2GTKI). IMA-treated patients were much older (median age 69 years, IQR 58-77) than the 2GTKI group (52, IQR 41-63) and had more comorbidities. Estimated 4-year overall survival of the entire cohort was 89% (95%CI 85.9-91.4). Overall, 73 patients (6.1%) died: 17 (2.8%) in the 2GTKI vs 56 (9.2%) in the IMA cohort (adjusted HR=0.50; 95% CI=0.26-0.94), but no differences were detected for CML-related mortality (10 (1.7%) vs 11 (1.8%) in the 2GTKIs vs IMA cohort (sHR=1.61; 0.52-4.96). The ELTS score was associated to CML mortality (high risk vs low, HR=9.67; 95%CI 2.94-31.74; p&lt;0.001), while age (per year, HR=1.03; 95%CI 1.00-1.06; p=0.064), CCI (4-5 vs 2, HR=5.22; 95%CI 2.56-10.65; p&lt;0.001), ELTS score (high risk vs low, HR=3.11; 95%CI 1.52-6.35, p=0.002) and 2GTKI vs IMA (HR=0.26; 95%CI 0.10-0.65, p=0.004) were associated to an increased risk of non-related CML mortality. The ELTS score showed a better discriminant ability than the Sokal score in all comparisons.

scholarly journals Factors Determining Periprocedural and Long-term Complications of High Risk Carotid Artery Stenting

2015 ◽  
Vol 42 (1) ◽  
pp. 48-54
Author(s):  
Vincent Dinculescu ◽  
Anne C.M. Ritter ◽  
Marlise P. dos Santos ◽  
Ravi M. Mohan ◽  
Betty A. Schwarz ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Large Scale ◽  
High Risk Patient ◽  
Patient Characteristics ◽  
High Risk Patients ◽  
Risk Patients

ABSTRACTBackground and Purpose: Carotid artery stenting (CAS) has been, historically, an alternative to open endarterectomy (CEA) for stroke prevention in high risk patients with carotid atherosclerosis. We sought to determine the rates of periprocedural and long-term stroke or death and the risk factors for complications after CAS in our high risk patient population. Methods: Clinical and treatment variables of consecutive CAS procedures performed between 2002 and 2011 were analyzed. Using univariate and multivariate logistic regression analyses we examined how patient characteristics influenced outcomes and changes in modified Rankin Score (mRS). Results: In 152 patients, the composite total of periprocedural death, stroke, transient ischemic attack (TIA) and myocardial infarction (MI) rate was 3.95% (6/152). Chronic kidney disease (CKD) was strongly associated with periprocedural complications (p<0.001). Coronary artery disease/peripheral vascular disease (CAD/PVD) (p=0.03), dyslipidemia (p=0.02), CKD (p=0.01), and contralateral internal carotid artery stenosis (p=0.02) were non-modifiable risk factors for mRS increase. There were 25 deaths, 8 strokes, 11 TIAs, and 1 MI (mean follow-up 38.4 months, range 0-116 months). The presence of CAD/PVD (p=0.009) and dyslipidemia (p=0.002) were significantly associated with long-term complications. Conclusion: CAS was performed with low periprocedural complications in high-risk patients. Our rates compare very favorably to large-scale trials that have ideal patients. This data encourages the consideration of CAS in patients considered high risk for CEA and provides possible patient characteristics (CKD) to help with periprocedural risk stratification.

LCIS and tamoxifen use: A single institution review

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1527-1527 ◽  
Author(s):  
L. J. Kirstein ◽  
Y. Martei ◽  
C. Roche ◽  
B. L. Smith ◽  
M. C. Specht ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Retrospective Chart Review ◽  
Invasive Cancer ◽  
High Risk Population ◽  
Single Institution ◽  
Entire Cohort ◽  
The Past ◽  
Risk Patients ◽  
Available Information

1527 Background: Results of the NSABP-P1 trial were published in 1998 showing a 50% reduction in breast cancer in the high- risk population with the use of tamoxifen. The use of tamoxifen is individualized, and depends on both patient and physician factors. We looked at the recommendations for and the use of tamoxifen in women with LCIS. Methods: A retrospective chart review at a single institution was performed from March 27, 1980 through September 19, 2005 for patients diagnosed with LCIS. Pathology and operative reports, as well as patient notes were reviewed for discussions about tamoxifen. Data was collected on whether a discussion took place, whether tamoxifen was or was not advised, whether the patient declined to take tamoxifen, whether they took it in the past or were currently on tamoxifen. We also examined the rate of DCIS and invasive cancer in this population. Results: There were 321 patients diagnosed with LCIS. Of those patients 193 were diagnosed after the publication of the P1 trial. Of these 193 patients we identified 104(54%) patients whose charts contained notes indicating a discussion about tamoxifen. The results of the discussion about tamoxifen are as follows: 21(20%) patients were currently taking tamoxifen, 16(15%) had taken it in the past, 37(36%) patients declined to take tamoxifen, and 17(16%) had not made a decision about taking tamoxifen. There were 13(13%) patients for whom tamoxifen was advised against. In the entire cohort of 321 patients, 15% went on to develop DCIS or invasive cancer in the first 12 years of follow up. We did not look at cancer rate Vs tamoxifen use due to the small numbers with available information. Conclusions: While the P1 trial recommends tamoxifen for breast cancer prevention in high-risk patients, in our experience, almost half of the patients did not have a documented discussion about the medication, and the majority of those who did decided not to take tamoxifen. This will likely have a large impact on the rate of DCIS and invasive breast cancer in this group. No significant financial relationships to disclose.

scholarly journals Simulation for Safety in the Pediatric Cardiac Catheterization Laboratory

2018 ◽  
Vol 02 (01) ◽  
pp. 010-013
Author(s):  
Ruchik Sharma
Keyword(s):  
High Risk ◽  
Cardiac Catheterization ◽  
Clinical Teaching ◽  
New Technology ◽  
Low Frequency ◽  
Aviation Industry ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Risk Environments ◽  
High Benefit

AbstractTreating congenital heart disease is a high-risk, high-benefit scenario, be it in the operating rooms or in cardiac catheterization labs. Inherent to the high-risk nature of the disease, adverse events of varying severity can happen during cath or surgical intervention. These have been traditionally the ‘real’ clinical teaching for the physician. Simulation technology helps physicians to be trained stress-free in zero-risk environments, especially for the low-frequency, high-risk events. But as always, introduction of new technology faces barriers, so is the case with simulators. Anesthesiology proudly compares itself to the aviation industry, which had also ridiculed aviation simulators in the 1970s. Now they are mandated by all worldwide aviation training authorities. Maybe its time for the anesthesiologists to take the lead in simulation in the health care sector too.

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