Background: Although the lungs are potentially highly susceptible to post-cardiac arrest syndrome injury, the issue of acute respiratory failure after out-of-hospital cardiac arrest has not been investigated. The objectives of this analysis were to determine the prevalence of acute respiratory failure after out-of-hospital cardiac arrest, its association with post-cardiac arrest syndrome inflammatory response and to clarify its importance for early mortality. Methods: The Post-Cardiac Arrest Syndrome (PCAS) pilot study was a prospective, observational, six-centre project (Poland 2, Denmark 1, Spain 1, Italy 1, UK 1), studying patients resuscitated after out-of-hospital cardiac arrest of cardiac origin. Primary outcomes were: (a) the profile of organ failure within the first 72 hours after out-of-hospital cardiac arrest; (b) in-hospital and short-term mortality, up to 30 days of follow-up. Respiratory failure was defined using a modified version of the Berlin acute respiratory distress syndrome definition. Inflammatory response was defined using leukocytes (white blood cells), platelet count and C-reactive protein concentration. All parameters were assessed every 24 hours, from admission until 72 hours of stay. Results: Overall, 148 patients (age 62.9±15.27 years; 27.7% women) were included. Acute respiratory failure was noted in between 50 (33.8%) and 75 (50.7%) patients over the first 72 hours. In-hospital and short-term mortality was 68 (46.9%) and 72 (48.6%), respectively. Inflammation was significantly associated with the risk of acute respiratory failure, with the highest cumulative odds ratio of 748 at 72 hours (C-reactive protein 1.035 (1.001–1.070); 0.043, white blood cells 1.086 (1.039–1.136); 0.001, platelets 1.004 (1.001–1.007); <0.005). Early acute respiratory failure was related to in-hospital mortality (3.172, 95% confidence interval 1.496–6.725; 0.002) and to short-term mortality (3.335 (1.815–6.129); 0.0001). Conclusions: An inflammatory response is significantly associated with acute respiratory failure early after out-of-hospital cardiac arrest. Acute respiratory failure is associated with a worse early prognosis after out-of-hospital cardiac arrest.

No abstract

Background: It has been suggested that a wider left main (LM) bifurcation angle is associated with the development of atherosclerosis. However, the relationship between LM trifurcation angulation and atherosclerosis has not been investigated. Aims:We aimed to investigate the relationship between LM trifurcation angulation and the presence of calcifications in the left coronary artery (LCA) using coronary computed tomography angiography (CCTA). Furthermore, we assessed the relationship between LM trifurcation angulation and the age at which calcification originated. Methods:The LM trifurcation angle and coronary artery calcium (CAC) score in the LCA were measured. Based on observational studies, we assumed that CAC progression is 25% per year on average. Then, we calculated the age at which LCA CAC scores were lower than 0.1 Agatston units.Results: Of 266 patients, 52 patients (mean age of [standard deviation, SD] 61 [6] years; 28 men) with LM trifurcation were included in the study. Calcified plaques occurred in the LCA in 36 patients (69.2%). The mean LM trifurcation angle in patients with a diseased LCA was wider than that in patients with a normal LCA (108° [33°] vs. 91° [28°]; P = 0.04). Pearson correlation coefficient showed that the wider the LM trifurcation angle was, the earlier the calcification in the LCA may be expected (r = -0.34; P = 0.04 with outliers; r = -0.43; P = 0.009 without outliers). Conclusions:A wider LM trifurcation angle is associated with a higher LCA CAC score. Moreover, the LM trifurcation angle has a significant impact on the earlier onset of atherosclerosis.

Purpose: Early graft dysfunction (EGD) is a major cause of morbidity and mortality following heart transplantation (HT). Severe EGD often includes the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Studies evaluating its effectiveness are mostly single centre observations with variable outcomes. This systematic review and metaanalysis appraises the available evidence and evaluates prognosis in HT patients with EGD requiring VA-ECMO. Methods: We conducted a systematic search of Ovid Medline, Embase and the Cochrane databases to 05/15/2020. Studies of adults who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint were included. We included observational studies published after 2009, in any language, as abstracts or full texts. Outcomes of interest were short-term mortality, 1-year mortality and VA-ECMO complications. We used QUIPS to assess risk of bias and GRADE to assess the quality of the evidence. Data was pooled using random-effects models. Results: We included 50 studies of 1472 patients with 504 short-term mortality events. Most studies were retrospective (94%), single centre (88%), and at low/acceptable risk of bias overall (76%). Pooled short-term mortality was 33% (95%CI: 27-38%, I 2 =76%) and 1-year mortality was 46% (95%CI: 37-54%, I 2 =81%). Risk of bias, publication type, recruitment timeframe, and use of VA-ECMO for only primary graft dysfunction as per the ISHLT definition did not explain heterogeneity in subgroup analyses. Reported VA-ECMO complications were 38% (95%CI: 27-49%) for dialysis, 36% (95%CI: 26-47%) for bleeding, 22% (95%CI: 14-31%) for infection and 5% (95%CI: 1-10%) for limb ischemia. Conclusion: One-third of HT patients with EGD supported with VA-ECMO are at risk of short-term death. An individual patient data metaanalysis is warranted to further understand the mortality risk and gain insight into risk factors associated with outcomes in this population.