European Heart Journal: Acute Cardiovascular Care最新文献

Patients with acute pulmonary embolism (PE) may present with cardiac arrest, overt or impending cardiogenic shock and/or severe respiratory insufficiency. Immediate evaluation and management of these patients require high clinical suspicion along with (bedside) imaging to confirm the diagnosis, targeted haemodynamic and/or respiratory support, appropriate anticoagulant treatment, and in many cases reperfusion therapy. The immediate treatment decision-making is largely driven by local expertise and resources and should be guided by the individual patient's characteristics such as cardiopulmonary comorbidities, risk of bleeding and location, extent and hemodynamic impact of the clot. Over the past years, treatment options for patients with severe PE have expanded substantially. For instance, several new catheter-guided reperfusion therapies have emerged and experience with circulatory mechanical support has increased. Along with the rise of new interventional therapies has come the introduction of expert multidisciplinary pulmonary embolism (EXPERT-PE) care teams, composed of multidisciplinary specialists involved in treating severe acute PE. This model of care provides a platform for rapid decisions on individualized treatment strategies, combining expert opinion from all involved specialties, setting the quality standards for modern local and regional equity PE care, and forming the base for future research in this area. Clinical decisions should be evidence-based where possible, and incorporate the individual patient's and their carer's preferences, values, and priorities, as well as those of the managing clinicians and care team. In this review, we summarize the evidence for the introduction of EXPERT-PE care teams and provide a practical manual for their successful implementation.

Psychological distress, moral injury and burnout are prevalent among intensive care unit (ICU) professionals, impacting individual well-being, team dynamics and patient safety. Structured peer support programs, delivered by trained colleagues rather than mental health professionals, could be implemented as low-threshold, scalable interventions to promote psychological safety and resilience. This review outlines five foundational pillars for implementing peer support in the ICU, including formal program design, training, inclusivity, confidentiality and continuous evaluation. It also addresses practical strategies to overcome cultural and institutional barriers, such as stigma, time constraints and hierarchical norms. Drawing on current evidence and recent unpublished survey data from North American critical care cardiologists, the article provides a practical framework for integrating peer support into ICU culture. Peer support represents a complementary approach to formal mental health services and offers tangible benefits for clinician well-being, retention and quality of care.

Acute kidney injury (AKI) is a sudden loss of renal function limited to 7 days with increased basal serum creatinine levels and/or decreased urinary production. AKI is a frequent condition in the intensive care unit (ICU) ranging from 13% to 36% in patients hospitalized with acute heart failure, up to 80% in patients with cardiogenic shock (CS). AKI requiring dialysis is also common (5% to 8%) and can exceed 13% in patients with CS. AKI is consistently associated with increased mortality in both the short-term, especially when dialysis is needed, and the long-term. The aim of this review is to provide an update on step-by-step management, from pharmacological treatment to renal replacement therapy, in patients with severe AKI in ICU patients with fluid overload.

Aims: Early repolarization patterns (ERPs) are a known risk factor for sudden cardiac death; however, their prognostic significance in cardiac arrest survivors remains unclear. This study aimed to investigate the clinical characteristics and outcomes of ERP in post-cardiac arrest survivors.

Methods and results: This observational cohort study included adult out-of-hospital cardiac arrest survivors (aged ≥18 years) who underwent targeted temperature management at two South Korean tertiary care centres between February 2018 and May 2023. Clinical, electrocardiogram (ECG), and outcome characteristics were compared between patients with and without ERP. Propensity score matching (PSM) was used to minimize confounding, followed by logistic regression analysis. The primary outcome was survival until the hospital discharge. Among the 693 post-resuscitation patients, 127 (18.3%) had ERP. The ERP cohort was characterized by a younger average age (59.0 vs. 64.1 years) and had lower peak levels of troponin I (1.7 vs. 4.5) and creatinine (1.2 vs. 1.4). Multivariable logistic regression analysis revealed that the ERP independently predicted decreased mortality at discharge (odds ratio: 1.68; 95% confidence interval: 1.04-2.72; P = 0.034) after adjusting for potential confounders. However, the difference in achieving favourable neurological outcomes was not statistically significant. These results were consistent within the matched cohort. After matching, groups showed no significant differences in post-resuscitation care variables or adverse events, except for maximum vasopressor doses.

Conclusion: The presence of ERP in post-resuscitation ECG was associated with a greater likelihood of survival until hospital discharge.