RESUMEN
AIM: To highlight an optimal collaborative strategy of three different levels of specialized care cardiac centres. BACKGROUND: Refractory cardiogenic shock is a life-threatening condition. A myocardial recovery is not achieved in many cases despite all efforts and subsequently the heart transplantation remains an ultimate option. Thereby, the use of extracorporeal membrane oxygenation (ECMO) followed by a ventricular assist device in staged bridging provides an attractive approach. CASE REPORT: We report on an optimal cooperation of PCI (percutaneous coronary intervention) centre with ELSO (extracorporeal life support organization) centre and transplant centre in a patient suffering from refractory cardiogenic shock due to acute myocardial infarction (RCSMI) complicated by left ventricle free wall rupture with pericardial tamponade. CONCLUSION: The interhospital collaboration can be essential in the context of patients with RCSMI. The use of ECMO enables safe interhospital transport and gains time for further diagnostic and therapeutic steps in such critically ill patients.
Asunto(s)
Trasplante de Corazón , Infarto del Miocardio con Elevación del ST/terapia , Choque Cardiogénico/terapia , Angioplastia Coronaria con Balón/métodos , Circulación Asistida , Unidades de Cuidados Coronarios , Oxigenación por Membrana Extracorpórea/métodos , Rotura Cardíaca Posinfarto/terapia , Corazón Auxiliar , Humanos , Relaciones Interinstitucionales , Masculino , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Choque Cardiogénico/diagnóstico por imagenRESUMEN
AIMS: Closed Loop Stimulation (CLS) pacemakers couple pacing rate to myocardial contraction dynamics by monitoring unipolar right ventricular impedance on a beat-to-beat basis. The aim of this large-scale registry was to evaluate the safety and efficacy of the CLS therapy under clinical routine conditions. METHODS AND RESULTS: A total of 706 patients was enrolled in the clinical investigation 'Registry: CYLOS Routine Documentation' (RECORD) at 57 investigational sites in Europe and Hong Kong. Not to interfere with clinical routine and therapeutic decisions of health care providers, the registry was implemented as a part of the standard follow-up schedule. Two follow-ups were conducted within 12 months of enrolment in order to evaluate typical programming of CLS-related parameters, reasons for their later reprogramming, frequency of patient intolerance to CLS, and physicians' satisfaction with medical benefits and technical performance of CLS in each patient. The investigators' medical and technical notes on CLS rated it excellent in ~80% of patients, poor in 1.4% (medical benefit) or 0.5% (technical performance), and adequate in rest of the patients. Closed Loop Stimulation functionality was not influenced by pacing site variation within the right ventricle (septal, outflow tract) or by advanced heart failure (New York Heart Association classes II-IV). Permanent or temporary CLS deactivation was undertaken for various reasons in 6.2% of patients. Signs of intolerance to CLS or rate-adaptive pacing were reported by 2.3% of patients. Reprogramming of CLS-related parameters was seldom undertaken, with >90% of pacemakers operating with default settings in the long term. CONCLUSION: Clinical performance of CLS was very satisfactory in the large cohort studied.