scholarly journals Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital

2017 ◽  
Vol 23 (1) ◽  
pp. 60-64 ◽  
Author(s):  
David L Ain ◽  
Mazen Albaghdadi ◽  
Jay Giri ◽  
Farhad Abtahian ◽  
Michael R Jaff ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Disease Process ◽  
Circulatory Support ◽  
Care Hospital ◽  
Imaging Data ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation

Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in relation to high-risk PE treatment and mortality. A single-center retrospective chart review was conducted of high-risk PE patients. High-risk PE was defined as acute PE and cardiac arrest or shock. A total of 60 patients were identified, 31 in the pre-ECMO era and 29 in the post-ECMO era. Mean age was 56.1±21.1 years and 51.7% were women. More patients in the post-ECMO era were identified with computed tomography (82.8% vs 51.6%, p=0.011) and more patients in the post-ECMO era had right ventricular dysfunction on echocardiography (96.4% vs 78.3%, p=0.045). No other differences were noted in baseline characteristics or clinical, laboratory and imaging data between the two groups. In total, ECMO was used in 13 (44.8%) patients in the post-ECMO era. There was greater utilization of catheter-directed therapies in the post-ECMO era compared to the pre-ECMO era ( n = 7 (24.1%) vs n = 1 (3.2%), p=0.024). Thirty-day survival increased from 17.2% in patients who presented in the pre-ECMO era to 41.4% in the post-ECMO era ( p=0.043). While more work is necessary to better identify those PE patients who stand to benefit from mechanical circulatory support, our findings have important implications for the management of such patients.

CLINICAL AND INVESTIGATIVE FEATURES OF SEIZURE IN CHILDREN ADMITTED IN TERTIARY CARE HOSPITAL OF NORTHERN INDIA

2021 ◽  
pp. 32-35
Author(s):  
Nikki Kumari ◽  
Rajesh Kumar ◽  
Gopal Saran ◽  
A. K. Jaiswal
Keyword(s):  
Ct Scan ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Disease Process ◽  
Cerebral Atrophy ◽  
Idiopathic Epilepsy ◽  
Care Hospital ◽  
Neck Stiffness ◽  
Altered Sensorium ◽  
Organ Systems

Introduction: Convulsions are one of the most common paediatric neurological disorders worldwide, with its incidence being highest among children younger than 3 years of age. It is also one of the most frequent causes for visit to the pediatric emergency department and could either be idiopathic or secondary to disease process of brain. Seizures lead to alterat Aims and objectives: ions in the laboratory values and reect changes in different organ systems. This study was done to evaluate the clinical, laboratory, EEG and CT ndings in cases of seizure among children between 1month to15years of age. It was a descriptive study conducted in patients admitt Materials and methods: ed in emergency and indoor of department of paediatrics, Patna Medical College and Hospital, over a period of 2 years from October 2014 to September 2016. Children from 1 month to 15 years of age with seizures were studied to know the proportion of idiopathic or secondary seizures and to evaluate various laboratory, EEG and CT ndings in these cases. During study period, 200 children between ages Results: 1 month to 15 years, with convulsion, were enrolled. Seizures were found to be more common in males (67.5%). Secondary seizures were present in 90% cases and idiopathic epilepsy accounted only for 10%. GTCS was the commonest type of seizure both in idiopathic epilepsy (100%) as well as in secondary seizure group (87.77%). Family history of seizure disorders was present in 13% of cases. Developmental delay was found in 11.5% cases, whereas 88.5% children were developmentally normal. Commonest symptoms associated with secondary seizures were fever (86.11%), altered sensorium (77.22%), and cough (38.89%). Headache, vomiting, ear discharge, rashes were other symptoms. Altered sensorium (69.5%), neck stiffness (33%), cranial nerve involvement (16%) were commonest signs. Hypocalcemia, hyponatremia and hypoglycaemia were found in 4.5%, 1.67% and 1.11% cases respectively, in cases of secondary seizures. CSF analysis was done in all 200 cases and was found to be normal in all cases (100%) of idiopathic epilepsy, whereas it was abnormal in 81% cases of secondary seizures. Abnormal CSF ndings included low CSF glucose (24.69% cases), high CSF proteins (100%) and CSF pleocytosis in 82.71% cases. EEG was also done in all cases, and was found to be abnormal in 85% cases of idiopathic epilepsy, whereas 43.89% cases of secondary seizures had abnormal recordings. Abnormal EEG recordings were abnormal background activity in 60.41%, generalised interictal discharges (IED) in 77.08% and focal IED in 21.87%. Abnormal CT scan ndings were seen in 60(45.8%) cases. Out of these 60 cases, commonest CT scan abnormalities seen were cerebral oedema (45%), cerebral atrophy (20%), and hydrocephalus (16.7%). Other CT ndings were ring enhancing lesions, basal exudates, infarcts etc.

scholarly journals National trends and outcomes for extra-corporeal membrane oxygenation use in high-risk pulmonary embolism

2019 ◽  
Vol 24 (3) ◽  
pp. 230-233 ◽  
Author(s):  
Ayman Elbadawi ◽  
Amgad Mentias ◽  
Islam Y Elgendy ◽  
Ahmed H Mohamed ◽  
Mohammed HZ Syed ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Temporal Trends ◽  
The United States ◽  
Teaching Hospitals ◽  
Definitive Treatment ◽  
Extra Corporeal Membrane Oxygenation ◽  
Observational Period ◽  
Membrane Oxygenation ◽  
National Trends

Little is known about the temporal trends and outcomes for extra-corporeal membrane oxygenation (ECMO) in patients with high-risk pulmonary embolism (PE) in the United States. We queried the National Inpatient Sample (NIS) database from 2005 to 2013 to identify patients admitted with high-risk PE. Our objective was to determine trends for ECMO use in patients with high-risk PE. We also assessed in-hospital outcomes among patients with high-risk PE receiving ECMO. We evaluated 77,809 hospitalizations for high-risk PE. There was an upward trend in the utilization of ECMO from 0.07% in 2005 to 1.1% in 2013 ( p = 0.015). ECMO was utilized more in urban teaching hospitals and large hospitals. ECMO use was associated with lower mortality in patients with massive PE ( p < 0.001). In-hospital mortality for patients receiving ECMO was 61.6%, with no change over the observational period ( p = 0.68). Our investigation revealed several independent predictors of increased mortality in patients with high-risk PE using ECMO as hemodynamic support, including: age, female sex, obesity, congestive heart failure, and chronic pulmonary disease. ECMO, therefore, as a rescue strategy or bridge to definitive treatment, may be effective in the management of high-risk PE when selecting patients with favorable clinical characteristics.

scholarly journals Use of monoclonal antibody therapy for nosocomial SARS-CoV-2 infection in patients at high risk for severe COVID-19: experience from a tertiary-care hospital in Germany

Infection ◽  
2021 ◽  
Author(s):  
Johanna Koehler ◽  
Barbara Ritzer ◽  
Simon Weidlich ◽  
Friedemann Gebhardt ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
High Risk ◽  
Tertiary Care Hospital ◽  
Severe Disease ◽  
Treatment Options ◽  
Tertiary Care ◽  
Antibody Therapy ◽  
Additional Treatment ◽  
Care Hospital ◽  
Cross Sectional ◽  
Asymptomatic Patients

AbstractAdditional treatment options for coronavirus disease (COVID-19) are urgently needed, particularly for populations at high risk of severe disease. This cross-sectional, retrospective study characterized the outcomes of 43 patients with nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with and without treatment using monoclonal SARS-CoV-2 spike antibodies (bamlanivimab or casirivimab/imdevimab). Our results indicate that treatment with monoclonal antibodies results in a significant decrease in disease progression and mortality when used for asymptomatic patients with early SARS-CoV-2 infection.

scholarly journals Point-of-care versus central testing of hemoglobin during large volume blood transfusion

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Justin Herman ◽  
Brian Park ◽  
Bharat Awsare ◽  
Frances West ◽  
Denine Crittendon ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Clinical Laboratory ◽  
Complete Blood Count ◽  
Point Of Care ◽  
Tertiary Care ◽  
Absolute Difference ◽  
Care Hospital ◽  
Specific Patient ◽  
Paired Samples ◽  
Clinically Significant

Abstract Background Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. Methods We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics. Results Fifty one percent (86 of 170) of paired samples’ hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of − 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was < 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. Conclusions The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was < 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is < 7 g/dL until further prospective trials are performed in this population.

scholarly journals The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

2015 ◽  
Vol 81 (9) ◽  
pp. 854-858 ◽  
Author(s):  
Rudy J. Judhan ◽  
Raquel Silhy ◽  
Kristen Statler ◽  
Mija Khan ◽  
Benjamin Dyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Tertiary Care ◽  
Disease Process ◽  
Pediatric Care ◽  
Care Hospital ◽  
Late Night ◽  
General Surgeons ◽  
The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

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