Background Cardiogenic shock is the main cause of death in hospitalized patients with acute coronary syndromes, with a high mortality rate. The management of graft thrombosis after coronary artery bypass graft (CABG) surgery is challenging and the best revascularization strategy is not well defined. In patients who develop cardiac arrest due to graft thrombosis, the benefits of mechanical support during advanced cardiac life support are uncertain. Rescue extracorporeal cardiac bypass resuscitation has been used in the context of cardiopulmonary arrest, with survival rates of around 34.7% of which 28.5% with good neurological outcome. Case summary We present here the case of a patient who developed cardiogenic shock after CABG graft occlusion. The patient suffered refractory cardiac arrest during percutaneous revascularization and received rescue cardiopulmonary support. Revascularization was achieved and there was a successful resuscitation with the placement of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella CP device. After a 29-day hospitalization the patient was discharged with no neurological sequelae. Discussion Although there is limited evidence of the benefit of a combined use of mechanical support (VA-ECMO with other mechanical devices) in the management of cardiogenic shock and cardiac arrest following CABG surgery, there seems to be a lower mortality with this approach, and possibly more favourable neurological outcomes. Further research is needed to elucidate the advantages of Impella vs. intra-aortic balloon pump combined with VA-ECMO in such patients.

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OR IC 95% p value Age 1.05 0.98--1.12 0.140 Female sex 0.47 0.15--1.45 0.190 Dependence 7.33 2.41--22.27 <0.001 Institutionalization 0.61 0.15--2.56 0,500 Dementia 29.59 3.36--260.45 <0.001 Psychoactive Drugs 13.8 0.48--4.02 0.550 Pre--op Albumin 0.59 0.23--1.50 0.270 BACKGROUND:Delirium is a frequent complication in patients hospitalized with femoral neck fracture, with a prevalence of 13-70%. Its occurrence is associated with increased morbidity and mortality. Several risk factors have been associated with the occurrence of delirium in patients hospitalized for femoral neck fracture, some of these considered modifiable. OBJECTIVS:1. Assess the prevalence of delirium in patients with femoral neck fracture (FNF) undergoing reduction and osteosynthesis (RO);2. Identify risk factors for the presence of delirium in this population. METHODS:WHAT? Observational, retrospective study of patients with FNF undergoing RO surgery alone;WHEN? From January to December of 2016;WHERE? In a tertiary university hospital.