Background The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications. Methods We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2. Results A total of 1644 patients with OHCA were included in this study. The patient age was 18–93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45–66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively. Conclusions In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.

Pulmonary arterial hypertension (PAH) is a rare, devastating disease, characterized by elevated pulmonary arterial pressure due to pulmonary microvascular obstruction, which can result in heart failure and death. PAH can be associated with exposure to certain drugs or toxins. We herein report a case in which PAH developed in a patient with refractory ulcerative colitis (UC) during treatment with "Qing-Dai," a Chinese herbal medicine. The patient's PAH improved after the discontinuation of Qing-Dai.

No abstract

exercise capacity and the quality of life (QOL) in patients with HFrEF, and reduces the rate of hospitalization due to any cause. 13,14 A meta-analysis showed that participation in an ECR program comprising moderate-intensity exercise increases patients' exercise capacity (measured as peak oxygen uptake [PV O2]) by approximately 13%. 15 In addition, participation in ECR after CRT has been reported to improve patients' PV O2 and QOL. 16 Therefore, cardiac rehabilitation is recommended by current heart failure practice guidelines at the Class I level. 1,17,18 H eart failure is a major public health problem and is associated with high morbidity and mortality. 1-3 In patients with chronic heart failure with reduced ejection fraction (HFrEF), cardiac resynchronization therapy (CRT) improves left ventricular ejection fraction (LVEF), 4-7 exercise capacity, and long-term survival. 5-9 Following CRT, patients' LVEF increases by approximately 10% points and left ventricular (LV) end-diastolic volume decreases by 20%; these changes are associated with better long-term prognoses. 10 However, up to 30% of patients show a poor response to CRT. 11 In these patients, LVEF does not improve after CRT. 12 Exercise-based cardiac rehabilitation (ECR) improves Editorial p ????