Journal and News Scan

This study used data from the International Registry of Acute Aortic Dissection to explore the rates and outcomes of root replacement vs more conservative management in patients with acute type A dissections.  Root replacement patients were younger, had greater root diameter, were more often affected by Marfans, had a higher incidence of AI, and were more often affected by shock/hypotension/tamponade.  Root replacement had no detrimental affect on hospital mortality or 3-year survival.

Program directors from 6 distinctly different training centers assessed educational costs for CT resident training.  Before formal accounting information was explored, the PDs estimated the annual cost per resident to be $250,000.  The actual costs per year per resident ranged from $330,000 to $667,000, with a mean of $483,000.  Faculty teaching costs made up more than half of the total costs, whereas simulation costs comprised 0 to $80,000.  The contributions of the residents to program savings averaged $37,000. 

This study determined the relationship of pre-hospital use of epinephrine during resuscitation to survival in patients who experienced return of spontaneous circulation after out of hospital cardiac arrest. 73% received epinephrine, and 17% of those patients experienced a good outcome (discharged alive with good neurologic status).  Of those who did not received epinephrine, 63% had a good outcome.  There was a dose-response effect.  Delayed administration of epinephrine had the worst outcomes. 

This is an excellent article on the feasibility of offering Veno Arterial ECMO in outlying community hospitals for Refractory Cardiogenic Shock (RCS).  The Authors review a four year time period and describe assessing 104 patients of whom 87 were deemed eligible for V-A ECMO therapy. The authors conclude that providing V-A ECMO therapy in a community hospital environment for RCS is both feasible and resulted in an impressive mortality reduction of 30%.  The Authors present points regarding the need for a constantly available dedicated staff, strong logistical support, and dedicated ICU beds. In addition, the authors discuss the probability of increased costs and resource utilization.