Acute and Critical Care

Original Articles

Infection
Association between 30-day mortality and serially measured hematologic markers in patients with septic shock in South Korea: Seungho Jung, Jeongmin Kim, Sungwon Na; Acute Crit Care. 2026;41(3):564-577. Published online August 31, 2026; DOI: https://doi.org/10.4266/acc.000858

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Abstract PDF Supplementary Material: Background
Hematologic markers derived from complete blood counts have emerged as potential cost-effective prognostic indicators. Sepsis-induced left ventricular diastolic dysfunction (LVDD) is associated with increased mortality rates. We evaluated the predictive value of serially measured hematologic markers for 30-day mortality and their relationship with LVDD in patients with septic shock. Methods: This retrospective cohort study analyzed adult patients diagnosed with septic shock in the emergency department of a university hospital between March 2014 and May 2018. Serial neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (LMR) values were recorded from admission to day 5. The relationship between hematologic markers and LVDD was evaluated in patients who underwent transthoracic echocardiography (TTE). Results: In total, 431 patients were included, with a 30-day mortality rate of 12.5%. The NLR on day 5 and NLR day 5/day 1 ratio had the highest predictive performance (area under the receiver operating characteristic curve [AUROC], 0.743 and 0.746, respectively). Similarly, the LMR on day 5 and the LMR day 5/day 1 ratio showed strong prognostic value (AUROC, 0.707 and 0.753, respectively). In the subgroup analysis of 204 patients who underwent TTE, a higher NLR at admission was significantly associated with LVDD (odds ratio, 1.016; 95% CI, 1.000–1.031; P=0.043). Conclusions: Serial measurements of the NLR and LMR showed better predictive value for 30-day mortality in patients with septic shock than measurements from a single time point. These findings support the use of hematologic markers as adjunctive tools for risk stratification of patients with septic shock.

CPR/Resuscitation
Esmolol in the management of refractory ventricular fibrillation: a systematic review and meta-analysis: Kathleen Lau, Yau-Lam Alex Chau, Ting-An Cheng, Michael Lai, David Seonguk Yeom, Ursula Ellis, Anthony Lau; Acute Crit Care. 2026;41(3):598-607. Published online August 19, 2026; DOI: https://doi.org/10.4266/acc.001675

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Abstract PDF Supplementary Material: Background
Refractory ventricular fibrillation (rVF) presents a significant challenge in advanced cardiovascular life support (ACLS), with traditional antiarrhythmics showing limited success in improving long-term survival and neurological function. Esmolol, a beta-1 selective adrenergic receptor antagonist, might offer benefits due to its rapid onset and catecholamine-suppressing effects during cardiac arrest. Methods: This systematic review and meta-analysis (SRMA) evaluates the effectiveness of esmolol in improving the temporary return of spontaneous circulation (ROSC), sustained ROSC, survival to discharge, and survival to discharge with favorable neurological outcomes in rVF patients. This SRMA reviewed Medline (Ovid), Embase (Ovid), and Cochrane Central (Ovid) from their inception until October 2, 2025, for full-text clinical or observational studies assessing esmolol use alongside standard ACLS in adult rVF in both prehospital and in-hospital settings. Results: The risk of bias was independently assessed using the Newcastle-Ottawa Scale. Pooled risk ratios (RRs; 95% CI) are reported. Analyses in which I² >50% used a random-effects model; otherwise, a common-effect model was used. Four studies (n=273) are included. Esmolol was associated with an increased temporary ROSC (RR, 1.80; 95% CI, 1.09–2.98), and although the links were not statistically significant, esmolol trended toward a benefit in sustained ROSC (RR, 1.25; 95% CI, 0.28–5.66), survival to discharge (RR, 1.08; 95% CI, 0.57–2.03), and survival to discharge with favorable neurological outcomes (RR, 2.08; 95% CI, 0.83–5.24). Conclusions: Esmolol was associated with improved temporary ROSC in rVF. The sensitivity analysis suggests potential benefits for sustained ROSC and neurological survival, but more data are needed. Further research is needed to clarify its role.

Cardiology
Right ventricular strain assessed by two-dimensional speckle tracking echocardiography and mortality in acute respiratory distress syndrome: a systematic review and meta-analysis: Eleni Xourgia, Dimitrios E. Katsaros, Ilias I. Siempos, Anastasia Kotanidou, Christina Routsi; Acute Crit Care. 2026;41(3):578-587. Published online May 19, 2026; DOI: https://doi.org/10.4266/acc.006025

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Abstract PDF Supplementary Material: Background
We investigated differences in right ventricular cardiac strain between survivor and non-survivor acute respiratory distress syndrome (ARDS) patients as measured by speckle tracking echocardiography. Methods: We conducted a systematic search of PubMed and Scopus for relevant articles reporting data on all-cause mortality and right cardiac speckle tracking echocardiography in ARDS patients. We considered studies published up to May 4, 2025. The primary objectives of the meta-analysis were right ventricular global and free-wall strain. A random effects model was used. Results: We included six studies with a total population of 359 individuals. While right ventricular global longitudinal strain of intubated ARDS patients (mean difference [95% CI], –2.30 [–4.13 to –0.47], P=0.01) was greater among non-survivors, free-wall strain (mean difference [95% CI], –2.78 [–6.83 to 1.27], P=0.18) was similar among groups. Among classic right ventricular echocardiographic indices, S prime and fractional area of change were lower among non-survivors, while still within normal range, while tricuspid annular plane systolic excursion was similar between groups. When exploring heterogeneity, we observed that removing outlier studies indicated consistently worse baseline right ventricular function among both strain and non-strain parameters. Conclusions: Although right ventricular function appears to be worse among non-survivor ARDS patients, results vary due to high heterogeneity among published studies. The role of right ventricular speckle tracking echocardiography as a non-invasive bedside means of quantifying myocardial dysfunction and predicting patient outcomes remains to be explored further in future trials.

Review Article

Cardiology
Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it: Seung-Jae Joo; Acute Crit Care. 2023;38(3):251-260. Published online August 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00955

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Abstract PDF

Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers’ benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable. Registry data have not showed the association of oral beta-blocker therapy with decreased mortality in survivors without heart failure or left ventricular systolic dysfunction after AMI. In the Korea Acute Myocardial Infarction Registry-National Institute of Health of in-hospital survivors after AMI, the benefit of beta-blocker therapy at discharge was shown in patients with reduced or mildly reduced EF, but not in those with preserved EF, which provides new information about beta-blocker therapy in patients without reduced EF. However, clinical practice can be changed when the results of appropriate randomized clinical trials are available. Ongoing clinical trials may help to answer the unresolved issues of beta-blocker therapy in patients with AMI.

Citations

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Finn Waagstein and the paradigm shift in the treatment of heart failure with β-adrenergic receptor antagonists (‘β-blockers’)
Kristina Lorenz, Ursula Ravens
Naunyn-Schmiedeberg's Archives of Pharmacology.2026; 399(3): 3133. CrossRef
Pharmacology of Atenolol: A β1-Selective Adrenoceptor Inhibitor
Mohammad Shah Amran, Nasrin Akhter, Fareha Anan Shristy, Sumaiya Rahman, Runa Akter, Mohammad Josim Uddin
Biomedical & Pharmacology Journal.2026; 1(19): 15. CrossRef
β2 adrenergic receptors orchestrate neutrophil demargination and recruitment to the ischemic heart following myocardial infarction
Albert Dahdah, Krishna P. Maremanda, Mathankumar Marimuthu, Ki Ho Park, Robert M. Jaggers, Dipanjan Chattopadhyay, Wang Qiang, Nitin Nitin, Stavros Stavrakis, Tarun W. Dasari, Viorel I. Șuicã, Raluca M. Boteanu, Elena Uyy, Felicia Antohe, Douglas G. Tille
Nature Communications.2026;[Epub] CrossRef
Reflections on Oral Beta Blocker Therapy and Long-term Outcomes after Myocardial Infarction in Preserved Left Ventricular Function
Reza Yaghoubi Nezhad, Hossein Zare, Ali Abasi
Cardiovascular Drugs and Therapy.2026;[Epub] CrossRef
Rosa davurica Pall. as a Functional Food in Ameliorating Acute Myocardial Ischemia: An Integrated Multi‐Omics Study on TNF‐α and Oxidative Stress
Zeyu Yi, Siyu Liu, Lincheng Bai, Fan Yang, Zhenkun Wang, Xiubo Zhu, Zunpeng Shu, Hua Han, Xiaojin Yu
Chemistry & Biodiversity.2026;[Epub] CrossRef
Chronic β-Blockade and Systemic Homeostasis: Molecular Integration of Cardiorenal and Immune Pathways, a Narrative Review
Jason Park, Amethyst Hamanaka, Issac Park, Hosam Gharib Abdelhady
Biomolecules.2025; 15(12): 1653. CrossRef
Beta-Blockers in Patients With Myocardial Infarction: A Meta-Analysis
Mushood Ahmed, Areeba Ahsan, Aimen Shafiq, Hasan Ahmad, Raheel Ahmed, Jamal S. Rana, Marat Fudim, Gregg C. Fonarow
American Journal of Therapeutics.2025; 32(4): e351. CrossRef
Neuroimmune Interactions and Their Role in Immune Cell Trafficking in Cardiovascular Diseases and Cancer
Yutang Wang, Jack C. Anesi, Indu S. Panicker, Darcy Cook, Prapti Bista, Yan Fang, Ernesto Oqueli
International Journal of Molecular Sciences.2025; 26(6): 2553. CrossRef
Elevated serum amylase concentrations are associated with worse in-hospital outcomes among patients with acute myocardial infarction
Marijana Mikacic, Marko Kumric, Iva Rancic Vidic, Duska Glavas, Tina Ticinovic Kurir, Josko Bozic, Josip Andelo Borovac
BMC Cardiovascular Disorders.2025;[Epub] CrossRef
Cardiac arrhythmia following acute myocardial infarction: a retrospective analysis of 27,648 hospitalized patients in a tertiary heart hospital
Nidal Asaad, Ayman El-Menyar, Rajvir Singh, Betsy Varughese, Shahul Hameed Khan, Hajar AlBinali, Jassim Al Suwaidi
Monaldi Archives for Chest Disease.2025;[Epub] CrossRef
Beta-Adrenergic Blockers for Acute Myocardial Infarction: 50 years of Expert Opinions in Cecil Textbook of Medicine
Peter Manu, Gheorghe-Andrei Dan
American Journal of Therapeutics.2025; 32(3): e274. CrossRef
Prognostic impact of changes in left ventricular ejection fraction and wall motion score index in patients with myocardial infarction
Min-Wook Bae, Seong-guen Moon, Kyung-Tae Jung, Won-Ho Kim, Sang-Hyun Park, Jihun Ahn, Jin-Yong Hwang, Seok Kyu Oh, Seung Ho Hur, Myung Ho Jung, Kyu-Sun Lee
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef
Identification and Validation of Calcium-Related Diagnostic Markers for Acute Myocardial Infarction via Bioinformatics Analysis and Machine Learning
Biao Wang, Jianhong Chen, Leili Wang, Yanli Liu, Liu Miao
International Heart Journal.2025; 66(4): 639. CrossRef
A hypoxia-on-a-chip platform for modeling ischemic arrhythmogenesis and evaluating the effects of levosimendan and OR-1896 on ischemic human iPSC-derived cardiomyocytes
Mahmoud Gaballah, Kaisla Walls, Fatma Zakzook, Joose Kreutzer, Jouko Levijoki, Katriina Aalto-Setälä
Frontiers in Bioengineering and Biotechnology.2025;[Epub] CrossRef
In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care
Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D. Henry, Kari Gorder
Expert Review of Cardiovascular Therapy.2024; 22(8): 379. CrossRef
Association between Inflammation and New-Onset Atrial Fibrillation in Acute Coronary Syndromes
Ruxandra-Maria Băghină, Simina Crișan, Silvia Luca, Oana Pătru, Mihai-Andrei Lazăr, Cristina Văcărescu, Alina Gabriela Negru, Constantin-Tudor Luca, Dan Gaiță
Journal of Clinical Medicine.2024; 13(17): 5088. CrossRef
Use of Early Intravenous Beta Blockers in Patients with Acute ST-Segment Elevation Myocardial Infarction Without Heart Failure—Revival or Requiem?
Azka Latif, Xiaoming Jia
Cardiovascular Drugs and Therapy.2024; 38(5): 973. CrossRef
Progress in Disease Modeling for Myocardial Infarction and Coronary Artery Disease: Bridging In Vivo and In Vitro Approaches
Riya Kar, Debabrata Mukhopadhyay, Ramcharan Singh Angom
Hearts.2024; 5(4): 429. CrossRef
Optimal duration of medical therapy for patients with acute myocardial infarction
Ki Yung Boo, Seung-Jae Joo, Jae-Geun Lee, Joon-Hyouk Choi, Song-Yi Kim, Geum Ko, Hae Eun Yun, Myung Ho Jeong
Medicine.2024; 103(48): e40697. CrossRef

Original Article

Nursing
Quality of life among patients with supraventricular tachycardia post radiofrequency cardiac ablation in Jordan: Mohammad Tayseer Al- Betar, Rami Masa'deh, Shaher H. Hamaideh, Fatma Refaat Ahmed, Hajar Bakkali, Mohannad Eid AbuRuz; Acute Crit Care. 2023;38(3):333-342. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00052

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Abstract PDF

Background
Supraventricular tachycardia (SVT) is a common arrhythmia with associated symptoms such as palpitation, dizziness, and fatigue. It significantly affects patients’ quality of life (QoL). Radiofrequency cardiac ablation (RFCA) is a highly effective treatment to eliminate arrhythmia and improve patients’ QoL. The purpose of this study was to assess the level of QoL among patients with SVT and examine the difference in QoL before and after RFCA.
Methods
One group pre-posttest design with a convenience sample of 112 patients was used. QoL was assessed by 36-Item Short Form (SF-36). Data were collected at admission through face-to-face interviews and 1-month post-discharge through phone interviews.
Results
There was a significant difference between QoL before (33.7±17.0) and 1 month after (62.5±18.5) the RFCA. Post-RFCA patients diagnosed with atrioventricular nodal reentrant tachycardia had higher QoL than other types of SVT. Moreover, there were significant negative relationships between QoL and the number and duration of episodes pre- and post-RFCA. There were no significant differences in QoL based on: age, sex, working status, marital status, smoking, coronary artery disease, diabetes mellitus, and hypertension.
Conclusions
After RFCA, the QoL of patients with ST improved for both physical and mental component subscales.

Citations

Citations to this article as recorded by

Supraventricular Tachycardia Ablation in the Elderly—Characteristics and Outcomes
Yi Yi Chua, Julian Cheong Kiat Tay, Eric Tien Siang Lim, Germaine Jie Min Loo, Wei Sheng Jonathan Ong, Xuanming Pung, Daniel Thuan Tee Chong, Kah Leng Ho, Chi Keong Ching
Journal of Arrhythmia.2026;[Epub] CrossRef
Supraventricular tachycardia in children
Zoha Nizami, Phoebe Garcia, Paras Ahuja, Aaron James Nipper, Sachi Patel, Hridhay Sheth, Induja Gajendran, Reshvinder Dhillon
Progress in Pediatric Cardiology.2025; 76: 101771. CrossRef
Frequency of Disabling Symptoms in Supraventricular Tachycardia
Hameed Ullah, Nasir Ali, Abdul Waris, Ihtisham Saeed, Abid Ullah, Nazeef Ullah
Indus Journal of Bioscience Research.2024; 2(2): 1448. CrossRef

Case Reports

Cardiology
Successful neural modulation of bedside modified thoracic epidural anesthesia for ventricular tachycardia electrical storm: Ki-Woon Kang; Acute Crit Care. 2024;39(4):643-646. Published online May 31, 2022; DOI: https://doi.org/10.4266/acc.2021.01683

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Abstract PDF

Ventricular tachycardia (VT)/ventricular fibrillation (VF) storm can be hemodynamically compromising and life-threatening. Management of medically refractory VT/VF storm is challenging in the intensive care unit. A 38-year-old male patient was diagnosed with non-ischemic heart failure and acute kidney injury with documented frequent premature ventricular contraction with QT prolongation after recurrent VT/VF. Even though the patient was intubated with sedatives and had taken more than two anti-arrhythmic drugs with external recurrent defibrillation at bedside, the electrical storm persisted for several hours. However, medically refractory VT/VF storm can be successfully and rapidly terminated with a modified thoracic epidural anesthesia at bedside. This case demonstrates that a bedside thoracic epidural anesthesia can be an effective non-pharmacological option to treat medically refractory VT/VF storm in the intensive care unit.

Citations

Citations to this article as recorded by

Spinal nociceptive denervation impedes subsequent chronic autonomic remodeling after myocardial infarction in male swine
Valerie Y. H. van Weperen, Jonathan D. Hoang, Neil R. Jani, Shail Avasthi, Christopher A. Chan, Kuan Cao, Zulfiqar A. Lokhandwala, Maryam Emamimeybodi, Karim Atmani, Marmar Vaseghi
Nature Communications.2026;[Epub] CrossRef
Stellate Ganglia: A Key Therapeutic Target for Malignant Ventricular Arrhythmia in Heart Disease
Yu-Long Li, Yu Li, Huiyin Tu, Anthony J. Evans, Tapan A. Patel, Hong Zheng, Kaushik P. Patel
Circulation Research.2025; 136(9): 1049. CrossRef
Neuromodulation of the Cardiac Autonomic Nervous System for Arrhythmia Treatment
Benjamin Wong, Yuki Kuwabara, Siamak Salavatian
Biomedicines.2025; 13(7): 1776. CrossRef
Continuous stellate ganglion block for ventricular arrhythmias: case series, systematic review, and differences from thoracic epidural anaesthesia
Veronica Dusi, Filippo Angelini, Enrico Baldi, Antonio Toscano, Carol Gravinese, Simone Frea, Sara Compagnoni, Arianna Morena, Andrea Saglietto, Eleonora Balzani, Matteo Giunta, Andrea Costamagna, Mauro Rinaldi, Anna Chiara Trompeo, Roberto Rordorf, Matte
Europace.2024;[Epub] CrossRef
Antiarrhythmic Mechanisms of Epidural Blockade After Myocardial Infarction
Jonathan D. Hoang, Valerie Y.H. van Weperen, Ki-Woon Kang, Neil R. Jani, Mohammed A. Swid, Christopher A. Chan, Zulfiqar Ali Lokhandwala, Robert L. Lux, Marmar Vaseghi
Circulation Research.2024;[Epub] CrossRef

Cardiology
Implantable cardioverter defibrillator as a treatment for massive left ventricular fibroma-induced ventricular arrhythmia in a child: In Su Choi, Hyung Ki Jeong, Hyung Wook Park, Yi-Seul Kim; Acute Crit Care. 2021;36(2):164-168. Published online May 28, 2021; DOI: https://doi.org/10.4266/acc.2020.00269

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Abstract PDF

Pediatric cardiac tumors are rare. Among these, cardiac fibroma is the second most common. Its clinical manifestations depend on size and location of the tumor and include arrhythmia or obstruction to blood flow. Symptomatic cardiac fibroma is generally treated with surgical resection or cardiac transplantation. We present the case of a 12-year-old boy with a lethal ventricular arrhythmia induced by a remnant tumor that was previously partially resected. An implantable cardioverter defibrillator was inserted as the arrhythmia was resistant to medical treatment. He was discharged in stable condition with an implantable cardioverter defibrillator generator and followed up in the outpatient clinic.

Citations

Citations to this article as recorded by

The management dilemma of a large left ventricular fibroma
Michael Gomes, Denae Moore, Wasing Taggu, Christoph Jensen, Kamil Stankowski, Andi Rroku, Deepti Ranganathan
European Heart Journal - Case Reports.2025;[Epub] CrossRef
Lipid emulsion attenuates propranolol-induced early apoptosis in rat cardiomyoblasts
Seong-Ho Ok, Seung Hyun Ahn, Soo Hee Lee, Hyun-Jin Kim, Gyujin Sim, Jin Kyeong Park, Ju-Tae Sohn
Human & Experimental Toxicology.2022;[Epub] CrossRef

CPR/Resuscitation
Successful resuscitation of refractory ventricular fibrillation with double sequence defibrillation: SungJoon Park, Jung-Youn Kim, Young-Duck Cho, Eusun Lee, Bosun Shim, Young-Hoon Yoon; Acute Crit Care. 2021;36(1):67-69. Published online October 21, 2020; DOI: https://doi.org/10.4266/acc.2020.00122

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Abstract PDF

In cardiac arrest, if the initial rhythm is ventricular fibrillation (VF) or pulseless ventricular tachycardia, the survival rates are high and good neurologic outcomes are expected. However, the mortality rate increases when refractory ventricular fibrillation (RVF) occurs. We report a case of RVF that was successfully resuscitated with double sequence defibrillation (DSD). A 51-year-old man visited the emergency department with chest pain. The initial electrocardiography showed markedly elevated ST-segment on V1–V5 leads, and VF arrest occurred. Although 10 defibrillations were administered over 20 minutes, there was no response. Two rounds of DSD were performed by placing additional pads on the patient’s anterior-posterior areas and sequentially applying the maximum energy setting. The patient returned to spontaneous circulation and was discharged with cerebral performance category 1 after 14 days of hospital admission. Therefore, DSD could be an option for treatment and termination of RVF.

Citations

Citations to this article as recorded by

Double Sequential Defibrillation for Refractory Ventricular Fibrillation During Resuscitative Thoracotomy: A Case Report
Summer Churchwell, Matthew Pinto, Joseph Doherty
Journal of the Mississippi State Medical Association.2026;[Epub] CrossRef
Double Sequential Defibrillation for Refractory Ventricular Fibrillation
Keerthi Eraniyan, Anjali Banerjee, Nadiya Amanda Persaud, Paul Banerjee
Academic Medicine & Surgery.2025;[Epub] CrossRef
Cardiac arrest: Pre-hospital strategies to facilitate successful resuscitation and improve recovery rates
George Latsios, Elias Sanidas, Maria Velliou, George Nikitas, Pavlos Bounas, Charalampos Parisis, Andreas Synetos, Konstantinos Toutouzas, Costas Tsioufis
World Journal of Cardiology.2025;[Epub] CrossRef
Keep shocking: Double sequential defibrillation for refractory ventricular fibrillation
Ahmed Kamal Mohamed, Mohamed Shakaib Nayaz, Ali Nawaz, Carl B Kapadia
The American Journal of Emergency Medicine.2023; 63: 178.e5. CrossRef

Original Article

Thoracic surgery
How small is enough for the left heart decompression cannula during extracorporeal membrane oxygenation?: Sua Kim, Jin Seok Kim, Jae Seung Shin, Hong Ju Shin; Acute Crit Care. 2019;34(4):263-268. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00577

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Abstract PDF

Background
Left ventricular (LV) distension is a recognizable problem accompanied by subsequent complications during venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, no gold standard for LV decompression has been established, and no minimal flow requirement has been designated. Thus, we evaluated the efficacy of the 8-Fr Mullins sheath for left heart decompression during VA-ECMO in adult patients.
Methods
Left heart decompression was performed when severe pulmonary edema was detected on chest radiography or when no generation of pulse pressure followed severe LV dysfunction in patients receiving VA-ECMO. We punctured the interatrial septum and inserted an 8-Fr Mullins sheath into the left atrium via the femoral vein. The sheath was connected to the venous catheter used for ECMO. The catheter was maintained during VA-ECMO.
Results
The left heart decompression procedure was performed in seven of 35 patients who received VA-ECMO between February 2017 and June 2018. Three patients had acute myocardial infarction; three, fulminant myocarditis; and one, dilated cardiomyopathy. Four patients showed noticeable improvement of pulmonary edema within 3 days, and three patients with a pulse pressure of <10 mm Hg showed an increase in pulse pressure of >20 mm Hg within 24 hours from the left heart decompression procedure. All seven patients were successfully weaned from VA-ECMO. No complications related to the left heart decompression procedure occurred.
Conclusions
An 8-Fr sheath may be a possible option for left heart decompression in adult patients with LV distension under VA-ECMO who are expecting recovery of LV function.

Citations

Citations to this article as recorded by

Venting during venoarterial extracorporeal membrane oxygenation
Enzo Lüsebrink, Leonhard Binzenhöfer, Antonia Kellnar, Christoph Müller, Clemens Scherer, Benedikt Schrage, Dominik Joskowiak, Tobias Petzold, Daniel Braun, Stefan Brunner, Sven Peterss, Jörg Hausleiter, Sebastian Zimmer, Frank Born, Dirk Westermann, Holg
Clinical Research in Cardiology.2023; 112(4): 464. CrossRef
Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review
Chengfen Yin, Lei Xu
Intensive Care Research.2023; 3(2): 131. CrossRef
Satisfactory outcome with activated clotting time <160 seconds in extracorporeal cardiopulmonary resuscitation
Beong Ki Kim, Jeong In Hong, Jinwook Hwang, Hong Ju Shin
Medicine.2022; 101(37): e30568. CrossRef
Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults
Ah‐Ram Kim, Hanbit Park, Sang‐Eun Lee, Jung‐Min Ahn, Duk‐Woo Park, Seung‐Whan Lee, Jae‐Joong Kim, Seung‐Jung Park, Jung Ae Hong, Pil‐Je Kang, Sung‐Ho Jung, Min‐Seok Kim
Artificial Organs.2021; 45(4): 390. CrossRef
Surgical minimal invasive left atrial decompression during venoarterial extracorporeal membrane oxygenation for pediatric acute fulminant myocarditis
Li Fen Ye, Qiang Shu, Chenmei Zhang, Yong Fan, Liyang Ying, Lijun Yang, Ru Lin
World Journal of Pediatric Surgery.2021; 4(4): e000291. CrossRef
Satisfactory outcome with low activated clotting time in extracorporeal membrane oxygenation
Jeong In Hong, Jinwook Hwang, Hong Ju Shin
Reviews in Cardiovascular Medicine.2021;[Epub] CrossRef
Increasing venoarterial extracorporeal membrane oxygenation flow puts higher demands on left ventricular work in a porcine model of chronic heart failure
Pavel Hála, Mikuláš Mlček, Petr Ošťádal, Michaela Popková, David Janák, Tomáš Bouček, Stanislav Lacko, Jaroslav Kudlička, Petr Neužil, Otomar Kittnar
Journal of Translational Medicine.2020;[Epub] CrossRef
Advanced Pulmonary and Cardiac Support of COVID-19 Patients
Keshava Rajagopal, Steven P. Keller, Bindu Akkanti, Christian Bime, Pranav Loyalka, Faisal H. Cheema, Joseph B. Zwischenberger, Aly El Banayosy, Federico Pappalardo, Mark S. Slaughter, Marvin J. Slepian
Circulation: Heart Failure.2020;[Epub] CrossRef
Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO—A “Living Working Document”
Keshava Rajagopal, Steven P. Keller, Bindu Akkanti, Christian Bime, Pranav Loyalka, Faisal H. Cheema, Joseph B. Zwischenberger, Aly El Banayosy, Federico Pappalardo, Mark S. Slaughter, Marvin J. Slepian
ASAIO Journal.2020; 66(6): 588. CrossRef

Case Reports

Pulmonary
Termination of Idiopathic Sustained Monomorphic Ventricular Tachycardia by Synchronized Electrical Cardioversion during Pregnancy: Sungmin Lee; Acute Crit Care. 2018;33(1):46-50. Published online February 20, 2017; DOI: https://doi.org/10.4266/acc.2016.00115

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Abstract PDF: The most common cardiac complications detected during pregnancy are an arrhythmia. However, idiopathic continuous monomorphic ventricular tachycardia (VT) during pregnancy is unusual. A 31-year-old pregnant woman presented at 20 weeks of gestation with progressive palpitation and episodes of agitation. An initial 12-lead electrocardiogram (ECG) showed normal sinus rhythm. However, 30 minutes after presenting at the emergency room, she complained of chest pain. A subsequent ECG showed wide complex monomorphic VT. We attempted to administer an antiarrhythmic drug, but the patient refused any medication because of concerns regarding possible adverse effects on the fetus. Therefore, we performed synchronized electrical cardioversion eight times. After the eighth synchronized cardioversion at 200 J, the ECG showed successful restoration of sinus rhythm. The condition of the fetus was monitored via ultrasonography and cardiotocography, and no adverse events were observed. We present the case of a successful synchronized electrical cardioversion performed in a woman at 20 weeks of gestation because of sustained symptomatic VT.

Cardiology
Recurrent Pulseless Ventricular Tachycardia Induced by Commotio Cordis Treated with Therapeutic Hypothermia: Sanghyun Lee, Hyunggoo Kang, Taeho Lim, Jaehoon Oh, Chiwon Ahn, Juncheal Lee, Changsun Kim; Korean J Crit Care Med. 2015;30(4):349-353. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.349

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Abstract PDF: The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33°C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.

Cardiology
Cardiac Arrest due to Recurrent Ventricular Fibrillation Triggered by Unifocal Ventricular Premature Complexes in a Silent Myocardial Infarction: Dong Hyun Lee, Seul Lee, Hyo Jin Jung, Soo Jin Kim, Jeong Min Seo, Jae Hyuk Choi, Jong Sung Park; Korean J Crit Care Med. 2014;29(4):331-335. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.331

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Abstract PDF: A 51-year-old male patient was referred for a sudden out-of-hospital cardiac arrest. Upon arrival, he was conscious and had no chest pain complaints. There was no abnormality in initial electrocardiographic and echocardiographic examinations. However, episodes of recurrent ventricular fibrillation (VF) were documented on rhythm monitoring. Each VF episode was triggered by an isolated monomorphic ventricular premature complex (VPC). Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.

Cardiology/Pulmonary
Dual Extracorporeal Membrane Oxygenation Support for Bridging Lung Transplantation in Acute Exacerbation of Idiopathic Pulmonary Fibrosis: Dong Jung Kim, Yeon Joo Lee, Jun Sung Kim, Sangheon Park, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):207-211. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.207

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Abstract PDF: When patients with severe respiratory failure are treated with venovenous extracorporeal membrane oxygenation (VV-ECMO), severe pulmonary hypertension due to right ventricular (RV) failure is possible. This is a serious complication that requires immediate therapeutic intervention. We report an extraordinary experience of additional venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for RV failure in a patient who was being treated with VV-ECMO as a bridge to lung transplantation. A 61-year-old man was diagnosed with acute exacerbation of idiopathic pulmonary fibrosis. While waiting for lung transplantation, he was placed on VV-ECMO and developed RV failure. After insertion of additional VA ECMO, RV dysfunction was dramatically improved. He underwent heart-lung transplantation after 23 days of dual ECMO support.

Cardiology
Thrombosis in the Left Ventricle after Implantable Cardioverter-Defibrillator Implantation: A Rare Cause of Systemic Thromboembolism: Hee Chan Jung, Woo Baek Chung, Man Young Lee; Korean J Crit Care Med. 2014;29(1):27-31. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.27

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Abstract PDF: This report describes a case of systemic thromboembolism caused by left ventricular (LV) thrombosis that developed after placement of an implantable cardioverter-defibrillator (ICD). A 27-year-old male patient was diagnosed with idiopathic dilated cardiomyopathy and ventricular tachycardia, and underwent ICD implantation for the primary prevention of sudden cardiac death. Two weeks after ICD implantation, the patient experienced renal infarction. Transthoracic echocardiography revealed a mobile thrombus at the LV apex, and automated function imaging demonstrated deteriorated LV function after ICD implantation. The RV was not placed by ICD and the mechanical force which was occurred by ICD that led to induced dyssynchronous motion of the LV apex may have resulted in a systemic thromboembolism.

Ventricular Fibrillation Soon after Endobronchial Epinephrine Application in a Young Man: A Case Report: Young Min Shin, Jong Hyung Kim, Hyung Wook Kim, Bo Sik Choi, Jin Gyu Jeong, Jung Won Hwang, Kwang Won Seo, Jong Joon Ahn, Seung Won Ra; Korean J Crit Care Med. 2011;26(4):276-280.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.276

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Abstract PDF

Ventricular fibrillation and cardiac arrest rarely occur after local application of epinephrine. Local and superficial application of epinephrine is a common hemostatic method during bronchoscopy, especially after biopsies. Although high plasma levels following endobronchial application of epinephrine have been observed in previous animal studies, there is no report of ventricular fibrillation after a usual dose of endobronchial application of epinephrine during bronchoscopy. We present a case of endobronchial epinephrine-induced ventricular fibrillation and cardiac arrest in a 31-year-old man with no previous history of cardiac disease.

Citations

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Stress Related Cardiomyopathy during Flexible Bronchoscopy
Jung Ar Shin, Ji Yoon Ha, Sang Yong Kim, Byoung Kwon Lee, Hyung Jung Kim, Chul Min Ahn, Yoon Soo Chang
Korean Journal of Critical Care Medicine.2013; 28(2): 127. CrossRef

Mitral Regurgitation due to Recurrent Septal Rupture after Repair of a Postinfarction Posterior Ventricular Septal Defect: A Case Report: Chan Beom Park, Ung Jin; Korean J Crit Care Med. 2009;24(1):39-41.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.39

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Abstract PDF: Postinfarction ventricular septal rupture (VSR) is a serious complication following an acute myocardial infarction. We performed repair of a postinfarction posterior VSR; however, the patient developed mitral regurgitation (MR) 2 months later. Geometrical changes caused by ventricular remodeling and recurrent shuntare thought to be the cause of delayed MR.

A Case of Accelerated Idioventricular Rhythm Lasted for 5 Days after Reperfusion in a Patient with Spasm-induce Myocardial Infaction: A Case Report: Kyoung Chan Kim, Il Soo Kim, Wook Kang, Jae Kyoon Kim, Chang Hoon Yu, Su Hong Kim; Korean J Crit Care Med. 2009;24(1):33-36.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.33

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Abstract PDF

A 56-year-old man presented with right coronary arterial spasm accompanied by ST segment elevation in the inferior leads. A reperfusion arrhythmia, accelerated idioventricular rhythm (AIVR), developed 1 hour after a nitroglycerin infusion. The AIVR was sustained for 5 days without hemodynamic instability, and resolved spontaneously during hemodynamic monitoring in the coronary intensive care unit.

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Successful Recovery after Cardiac Arrest from Medically Intractable Coronary Spasm Induced by Ergonovine, Using Percutaneous Cardiopulmonary Support - A Case Report -
Jeehoon Kang, In-Chang Hwang, Chang-Hwan Yoon
Korean Journal of Critical Care Medicine.2012; 27(4): 269. CrossRef

Original Articles

Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy: Jin Hee Kim, Byung Moon Ham, Yong Lak Kim, Yoon Seok Jeon, Sung Hee Han, Jae Sang Sung, Ki Bong Kim, Hyeong Ryul Kim; Korean J Crit Care Med. 2002;17(2):100-106.

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Abstract PDF: BACKGROUND
Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy.
METHODS
EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit.
RESULTS
Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively.
CONCLUSIONS
EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.

Diagnosis of Right Ventricular Dysfunction in Acute Pulmonary Embolism with N-terminal Probrain Natriuretic Peptide (NT-proBNP): Young Ju Lee; Korean J Crit Care Med. 2006;21(2):83-88.

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Abstract PDF: BACKGROUND
Patients with pulmonary embolism are at high risk of death because of right ventricular dysfunction (RVD) and mortality rate increases with worsening right ventricular dysfuction. The utility of N-terminal probrain natriuretic peptide (NT-proBNP) testing in the emergency department for diagnosing right ventricular dysfunction with pulmonary embolism and optimal cut-off points for its uses are not well established.
METHODS
Forty-nine consecutive patients with confirmed pulmonary embolism, who visited our emergency medical center from March 2005 to September 2006, were recruited. Patients with congestive heart failure and chronic renal failure were excluded from study enrollment. The diagnosis of right ventricular dysfunction was based on echocardiographic evidence of right ventricular dysfunction.
RESULTS
The mean age was 68+/-11 yr, and 71% of the patients were women. The median NT-proBNP level among 29 patients (59%) who had RVD was 1296 versus 250 pg/ml for those 20 patients (41%) who did not have RVD (p=0.01). The area under the receiver operating characteristic curve was 0.94 (95% CI of 0.89~0.98). At a cutoff of 400 pg/ml, NT-proBNP had a sensitivity of 97%, a specificity of 75%, and an overall accuracy of 88% for RVD (p=0.01). An NT-proBNP level <400 pg/ml was optimal for ruling out RVD, which was a negative predictive value of 94%. Increased NT- proBNP was the strong independent predictor of RVD (odds ratio 13, 95% CI 4.3-39.0, p=0.01).
CONCLUSIONS
NT-proBNP levels are frequently increased in patients with pulmonary embolism who have RVD than who did not have RVD. In acute pulmonary embolism, NT-proBNP elevation is highly predictive of RVD.

Case Report

Pharmacological Cardioversion with Phenylephrine for Paroxysmal Supraventricular Tachycardia during Lung Resection Surgery: A Case Report: Hyun Jung Kim, Soo Kyung Lee, Young Mi Kim, Hyun Soo Moon; Korean J Crit Care Med. 2006;21(1):57-62.

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Abstract PDF: Supraventricular arrhythmias during and after thoracotomy for pulmonary resections are well documented, and risk factors of post-pulmonary resection arrhythmias are old age, magnitude of surgery, and coexisting cardiopulmonary disease etc. Among of supraventricular arrhythmias, atrial fibrillation is the most common rhythm disturbance that may be associated with increased morbidity and mortality. We experienced a case of paroxysmal supraventricular tachycardia with severe hypotension which was escalated from atrial fibrillation during pulmonary bilobectomy for tuberculosis in a 44-year old male patient. Instead of usual electrical cardioversion or common antiarrhythmic agents, we selected phenylephrine bolus injection which induced normal sinus rhythm successfully from paroxysmal supraventricular tachycardia of the patient.

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