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Gregers E, Frederiksen PH, Udesen NLJ, Linde L, Banke A, Povlsen AL, Larsen JP, Hassager C, Jensen LO, Lassen JF, Schmidt H, Ravn HB, Heegaard PMH, Møller JE. Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock. Intensive Care Med Exp 2024; 12:39. [PMID: 38647741 PMCID: PMC11035503 DOI: 10.1186/s40635-024-00625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine cardiogenic shock model managed with V-A ECMO or ECMELLA. METHODS Fourteen landrace pigs had acute myocardial infarction-induced cardiogenic shock with minimal arterial pulsatility by microsphere embolization and were afterwards managed 1:1 with either V-A ECMO or ECMELLA for 4 h. Serial blood samples were drawn hourly and analyzed for serum concentrations of interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha, and serum amyloid A (SAA). RESULTS An increase in IL-6, IL-8, and SAA levels was observed during the experiment for both groups. At 2-4 h of support, IL-6 levels were higher in ECMELLA compared to V-A ECMO animals (difference: 1416 pg/ml, 1278 pg/ml, and 1030 pg/ml). SAA levels were higher in ECMELLA animals after 3 and 4 h of support (difference: 401 ng/ml and 524 ng/ml) and a significant treatment-by-time effect of ECMELLA on SAA was identified (p = 0.04). No statistical significant between-group differences were observed in carotid artery blood flow, urine output, and lactate levels. CONCLUSIONS Left ventricular unloading with Impella during V-A ECMO resulted in a more extensive inflammatory reaction despite similar end-organ perfusion.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark.
| | | | - Nanna L J Udesen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Amalie L Povlsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jeppe P Larsen
- Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesiology, Odense University Hospital, Odense, Denmark
| | - Peter M H Heegaard
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jacob E Møller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen O, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Frederiksen PH, Linde L, Gregers E, Udesen NLJ, Helgestad OK, Banke A, Dahl JS, Jensen LO, Lassen JF, Povlsen AL, Larsen JP, Schmidt H, Ravn HB, Møller JE. Haemodynamic implications of VA-ECMO vs. VA-ECMO plus Impella CP for cardiogenic shock in a large animal model. ESC Heart Fail 2024. [PMID: 38649295 DOI: 10.1002/ehf2.14780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with profound left ventricular (LV) failure is associated with inadequate LV emptying. To unload the LV, VA-ECMO can be combined with Impella CP (ECMELLA). We hypothesized that ECMELLA improves cardiac energetics compared with VA-ECMO in a porcine model of cardiogenic shock (CS). METHODS AND RESULTS Land-race pigs (weight 70 kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. CS was induced with embolization in the left main coronary artery. CS was defined as reduction of ≥50% in cardiac output or mixed oxygen saturation (SvO2) or a SvO2 < 30%. At CS VA-ECMO was initiated and embolization was continued until arterial pulse pressure was <10 mmHg. At this point, Impella CP was placed in the ECMELLA arm. Support was maintained for 4 h. CS was induced in 15 pigs (VA-ECMO n = 7, ECMELLA n = 8). At time of CS MAP was <45 mmHg in both groups, with no difference at 4 h (VA-ECMO 64 mmHg ± 11 vs. ECMELLA 55 mmHg ± 21, P = 0.08). Carotid blood flow and arterial lactate increased from CS and was similar in VA-ECMO and ECMELLA [239 mL/min ± 97 vs. 213 mL/min ± 133 (P = 0.6) and 5.2 ± 3.3 vs. 4.2 ± 2.9 mmol/ (P = 0.5)]. Pressure-volume area (PVA) was significantly higher with VA-ECMO compared with ECMELLA (9567 ± 1733 vs. 6921 ± 5036 mmHg × mL/min × 10-3, P = 0.014). Total diureses was found to be lower in VA-ECMO compared with ECMELLA [248 mL (179-930) vs. 506 mL (418-2190); P = 0.005]. CONCLUSIONS In a porcine model of CS, we found lower PVA, with the ECMELLA configuration compared with VA-ECMO, indicating better cardiac energetics without compromising systemic perfusion.
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Affiliation(s)
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Emilie Gregers
- Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nanna L J Udesen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ole K Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ann Banke
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Amalie L Povlsen
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Jeppe P Larsen
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Hanne B Ravn
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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3
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Ørnbjerg LM, Brahe CH, Linde L, Jacobsson L, Nissen MJ, Kristianslund EK, Santos MJ, Nordström D, Rotar Z, Gudbjornsson B, Onen F, Codreanu C, Lindström U, Möller B, Kvien TK, Barcelos A, Eklund KK, Tomšič M, Love TJ, Can G, Ionescu R, Loft AG, Mann H, Pavelka K, van de Sande M, van der Horst-Bruinsma IE, Suarez MP, Sánchez-Piedra C, Macfarlane GJ, Iannone F, Michelsen B, Hyldstrup LH, Krogh NS, Østergaard M, Hetland ML. Drug effectiveness of 2nd and 3rd TNF inhibitors in psoriatic arthritis - relationship with the reason for withdrawal from the previous treatment. Joint Bone Spine 2024; 91:105729. [PMID: 38582359 DOI: 10.1016/j.jbspin.2024.105729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To investigate real-world retention and remission rates in PsA patients initiating a 2nd or 3rd TNFi and the association with reason for discontinuation from the previous TNFi-treatment. METHODS Prospectively collected routine care data from 12 European registries were pooled. Retention rates (Kaplan-Meier estimation) and crude/LUNDEX-adjusted rates of Disease Activity Score 28 and Disease Activity index for PSoriatic Arthritis (DAS28 and DAPSA28) remission were calculated and compared with adjusted Cox regression analyses and Chi-squared test, respectively). RESULTS We included 5233 (2nd TNFi) and 1906 (3rd TNFi) patients. Twelve-month retention rates for the 2nd and 3rd TNFi were 68% (95%CI: 67-70%) and 66% (64-68%), respectively. Patients who stopped the previous TNFi due to AE/LOE had 12-month retention rates of 66%/65% (2nd TNFi), and 65%/63% (3rd TNFi), respectively. Patients who stopped the previous TNFi due to LOE after less vs more than 24 weeks had 12-month retention rates of 54%/69% (2nd TNFi), and 58%/65% (3rd TNFi). Six-month crude/LUNDEX-adjusted DAS28 remission rates were 48%/35% and 38%/27%, and DAPSA28 remission rates were 19%/14% and 14%/10%, for the 2nd and 3rd TNFi. CONCLUSION Two-thirds of patients remained on TNFi at 12months for both the 2nd and 3rd TNFi, while one-third and one-quarter of patients were in DAS28 remission after 6months on the 2nd and 3rd TNFi. While drug effectiveness was similar in patients who stopped the previous TNFi due to AE compared to overall LOE, drug effectiveness was better in patients who had stopped the previous TNF due to secondary LOE compared to primary LOE.
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Affiliation(s)
- Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
| | - Cecilie Heegaard Brahe
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Louise Linde
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Eirik Klami Kristianslund
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria José Santos
- Reuma.pt registry; Department of Rheumatology-Hospital Garcia de Orta, Almada and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Dan Nordström
- ROB-FIN Registry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ziga Rotar
- biorx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fatos Onen
- TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey
| | - Catalin Codreanu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Burkhard Möller
- Leitender Arzt der Universitätsklinik für Rheumatologie, Immunologie und Allergologie Inselspital, Bern, Switzerland
| | - Tore K Kvien
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anabela Barcelos
- Reuma.pt registry, Rheumatology Department - Centro Hospitalar do Baixo Vouga, Aveiro and Comprehensive Health Research Center (CHRC), NOVA University of Lisbon, Lisboa, Portugal
| | - Kari K Eklund
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Matija Tomšič
- biorx.si and the Department of Rheumatology, University Medical Centre Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thorvardur Jon Love
- University of Iceland, Faculty of Medicine, and Landspitali University Hospital, Reykjavik, Iceland
| | - Gercek Can
- TURKBIO Registry and Division of Rheumatology, School of Medicine Dokuz Eylul University, Izmir, Turkey
| | - Ruxandra Ionescu
- Center of Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Anne Gitte Loft
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marleen van de Sande
- Amsterdam UMC, University of Amsterdam, Department of Clinical Immunology and Rheumatology, Amsterdam, The Netherlands; Amsterdam Rheumatology & immunology Center (ARC), Academic Medical Center, Amsterdam, The Netherlands
| | | | - Manuel Pombo Suarez
- Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Santiago, Spain
| | | | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group) University of Aberdeen, Aberdeen, United Kingdom
| | - Florenzo Iannone
- GISEA registry, Rheumatology Unit-DETO, University of Bari, Bari, Italy
| | - Brigitte Michelsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland; Research Unit, Sørlandet Hospital, Kristianssand, Norway
| | - Lise Hejl Hyldstrup
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | | | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gregers E, Kragholm K, Linde L, Mørk SR, Andreasen JB, Terkelsen CJ, Lassen JF, Møller JE, Laugesen H, Smerup M, Kjærgaard J, Møller-Sørensen PH, Holmvang L, Torp-Pedersen C, Hassager C, Søholm H. Return to Work After Refractory Out-of-Hospital Cardiac Arrest in Patients Managed With or Without Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Register-Based Study. J Am Heart Assoc 2024; 13:e034024. [PMID: 38533974 DOI: 10.1161/jaha.123.034024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory out-of-hospital cardiac arrest (OHCA). However, survivors managed with ECPR are at risk of poor functional status. The purpose of this study was to investigate return to work (RTW) after refractory OHCA. METHODS AND RESULTS Of 44 360 patients with OHCA in the period of 2011 to 2020, this nationwide registry-based study included 805 patients with refractory OHCA in the working age (18-65 years) who were employed before OHCA (2% of the total OHCA cohort). Demographics, prehospital characteristics, status at hospital arrival, employment status, and survival were retrieved through the Danish national registries. Sustainable RTW was defined as RTW for ≥6 months without any long sick leave relapses. Median follow-up time was 4.1 years. ECPR and standard advanced cardiovascular life support were applied in 136 and 669 patients, respectively. RTW 1 year after OHCA was similar (39% versus 54%; P=0.2) and sustainable RTW was high in both survivors managed with ECPR and survivors managed with standard advanced cardiovascular life support (83% versus 85%; P>0.9). Younger age and shorter length of hospitalization were associated with RTW in multivariable Cox analysis, whereas ECPR was not. CONCLUSIONS In refractory OHCA-patients employed prior to OHCA, approximately 1 out of 2 patients were employed after 1 year with no difference between patients treated with ECPR or standard advanced cardiovascular life support. Younger age and shorter length of hospitalization were associated with RTW while ECPR was not.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology Rigshospitalet Copenhagen Denmark
| | - Kristian Kragholm
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Louise Linde
- Department of Cardiology Odense University Hospital Odense Denmark
| | | | | | - Christian Juhl Terkelsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Jens Flensted Lassen
- Department of Cardiology Odense University Hospital Odense Denmark
- Department of Clinical Medicine University of Southern Denmark Copenhagen Denmark
| | - Jacob Eifer Møller
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Cardiology Odense University Hospital Odense Denmark
- Department of Clinical Medicine University of Southern Denmark Copenhagen Denmark
| | - Helle Laugesen
- Department of Anaesthesiology Aalborg University Hospital Aalborg Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | | | | | - Lene Holmvang
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology North Zealand Hospital Hillerød Denmark
- Department of Public Health Copenhagen University Copenhagen Denmark
| | - Christian Hassager
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Helle Søholm
- Department of Cardiology Rigshospitalet Copenhagen Denmark
- Department of Cardiology Zealand University Hospital Roskilde Roskilde Denmark
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5
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Gregers E, Linde L, Kunkel JB, Wiberg S, Møller-Sørensen PH, Smerup M, Borregaard B, Schmidt H, Lassen JF, Møller JE, Hassager C, Søholm H, Kjærgaard J. Health-related quality of life and cognitive function after out-of-hospital cardiac arrest; a comparison of prehospital return-of-spontaneous circulation and refractory arrest managed with extracorporeal cardiopulmonary resuscitation. Resuscitation 2024; 197:110151. [PMID: 38401709 DOI: 10.1016/j.resuscitation.2024.110151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) for selected refractory out-of-hospital cardiac arrest (OHCA) is increasingly used. Detailed knowledge of health-related quality of life (HRQoL) and long-term cognitive function is limited. HRQoL and cognitive function were assessed in ECPR-survivors and OHCA-survivors with prehospital return of spontaneous circulation after standard advanced cardiac life support (sACLS). METHODS Fifteen ECPR-survivors and 22 age-matched sACLS-survivors agreed to participate in this follow-up study. Participants were examined with echocardiography, 6-minute walk test, and neuropsychological testing, and answered HRQoL (EQ-5D-5L and Short Form 36 (SF-36)), and mental health questionnaires. RESULTS Most patients were male (73 % and 82 %) and median age at follow-up was similar between groups (55 years and 60 years). Low flow time was significantly longer for ECPR-survivors (86 min vs. 15 min) and lactate levels were significantly higher (14.1 mmol/l vs. 3.9 mmol/l). No between-group difference was found in physical function nor in cognitive function with scores corresponding to the 23rd worst percentile of the general population. SACLS-survivors had HRQoL on level with the Danish general population while ECPR-survivors scored lower in both EQ-5D-5L (index score 0.73 vs. 0.86, p = 0.03, visual analog scale: 70 vs. 84, p = 0.04) and in multiple SF-36 health domains (role physical, bodily pain, general health, and mental health). CONCLUSIONS Despite substantially longer low flow times with thrice as high lactate levels, ECPR-survivors were similar in cognitive and physical function compared to sACLS-survivors. Nonetheless, ECPR-survivors reported lower HRQoL overall and related to mental health, pain management, and the perception of limitations in physical role.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark.
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Joakim Bo Kunkel
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Cardiothoracic Anaesthestiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | | | - Morten Smerup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesiology, Odense University Hospital, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Copenhagen University, Denmark
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6
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Thevathasan T, Füreder L, Fechtner M, Mørk SR, Schrage B, Westermann D, Linde L, Gregers E, Andreasen JB, Gaisendrees C, Unoki T, Axtell AL, Takeda K, Vinogradsky AV, Gonçalves-Teixeira P, Lemaire A, Alonso-Fernandez-Gatta M, Sern Lim H, Garan AR, Bindra A, Schwartz G, Landmesser U, Skurk C. Left-Ventricular Unloading With Impella During Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis. Crit Care Med 2024; 52:464-474. [PMID: 38180032 PMCID: PMC10876179 DOI: 10.1097/ccm.0000000000006157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Extracorporeal cardiopulmonary resuscitation (ECPR) is the implementation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest. The role of left-ventricular (LV) unloading with Impella in addition to VA-ECMO ("ECMELLA") remains unclear during ECPR. This is the first systematic review and meta-analysis to characterize patients with ECPR receiving LV unloading and to compare in-hospital mortality between ECMELLA and VA-ECMO during ECPR. DATA SOURCES Medline, Cochrane Central Register of Controlled Trials, Embase, and abstract websites of the three largest cardiology societies (American Heart Association, American College of Cardiology, and European Society of Cardiology). STUDY SELECTION Observational studies with adult patients with refractory cardiac arrest receiving ECPR with ECMELLA or VA-ECMO until July 2023 according to the Preferred Reported Items for Systematic Reviews and Meta-Analysis checklist. DATA EXTRACTION Patient and treatment characteristics and in-hospital mortality from 13 study records at 32 hospitals with a total of 1014 ECPR patients. Odds ratios (ORs) and 95% CI were computed with the Mantel-Haenszel test using a random-effects model. DATA SYNTHESIS Seven hundred sixty-two patients (75.1%) received VA-ECMO and 252 (24.9%) ECMELLA. Compared with VA-ECMO, the ECMELLA group was comprised of more patients with initial shockable electrocardiogram rhythms (58.6% vs. 49.3%), acute myocardial infarctions (79.7% vs. 51.5%), and percutaneous coronary interventions (79.0% vs. 47.5%). VA-ECMO alone was more frequently used in pulmonary embolism (9.5% vs. 0.7%). Age, rate of out-of-hospital cardiac arrest, and low-flow times were similar between both groups. ECMELLA support was associated with reduced odds of mortality (OR, 0.53 [95% CI, 0.30-0.91]) and higher odds of good neurologic outcome (OR, 2.22 [95% CI, 1.17-4.22]) compared with VA-ECMO support alone. ECMELLA therapy was associated with numerically increased but not significantly higher complication rates. Primary results remained robust in multiple sensitivity analyses. CONCLUSIONS ECMELLA support was predominantly used in patients with acute myocardial infarction and VA-ECMO for pulmonary embolism. ECMELLA support during ECPR might be associated with improved survival and neurologic outcome despite higher complication rates. However, indications and frequency of ECMELLA support varied strongly between institutions. Further scientific evidence is urgently required to elaborate standardized guidelines for the use of LV unloading during ECPR.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Department of Cardiology and Angiology, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Aneastesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
- Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación biomédica en Red de Enfermadades Cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX
| | - Lisa Füreder
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Marie Fechtner
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
| | | | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jo Bønding Andreasen
- Department of Aneastesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Takashi Unoki
- Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Andrea L Axtell
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Koji Takeda
- Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Alice V Vinogradsky
- Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY
| | | | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Marta Alonso-Fernandez-Gatta
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación biomédica en Red de Enfermadades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Hoong Sern Lim
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Arthur Reshad Garan
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Amarinder Bindra
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX
| | - Gary Schwartz
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Department of Cardiology and Angiology, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Aneastesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
- Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Centro de Investigación biomédica en Red de Enfermadades Cardiovasculares (CIBER-CV), Madrid, Spain
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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7
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Linde L, Ørnbjerg LM, Georgiadis S, H. Rasmussen S, Lindström U, Askling J, Michelsen B, Di Giuseppe D, Wallman JK, Gudbjornsson B, Love TJ, Nordström DC, Yli-Kerttula T, Nekvindová L, Vencovský J, Iannone F, Cauli A, Loft AG, Glintborg B, Laas K, Rotar Z, Tomšič M, Macfarlane GJ, Möller B, van de Sande M, Codreanu C, Nissen MJ, Birlik M, Erten S, Santos MJ, Vieira-Sousa E, Hetland ML, Østergaard M. Predictors of DAPSA28 remission in patients with psoriatic arthritis initiating a first TNF inhibitor: results from 13 European registries. Rheumatology (Oxford) 2024; 63:751-764. [PMID: 37314967 PMCID: PMC10907817 DOI: 10.1093/rheumatology/kead284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES In bio-naïve patients with PsA initiating a TNF inhibitor (TNFi), we aimed to identify baseline predictors of Disease Activity index for PsA in 28 joints (DAPSA28) remission (primary objective) and DAPSA28 moderate response at 6 months, as well as drug retention at 12 months across 13 European registries. METHODS Baseline demographic and clinical characteristics were retrieved and the three outcomes investigated per registry and in pooled data, using logistic regression analyses on multiply imputed data. In the pooled cohort, selected predictors that were either consistently positive or negative across all three outcomes were defined as common predictors. RESULTS In the pooled cohort (n = 13 369), 6-month proportions of remission, moderate response and 12-month drug retention were 25%, 34% and 63% in patients with available data (n = 6954, n = 5275 and n = 13 369, respectively). Five common baseline predictors of remission, moderate response and 12-month drug retention were identified across all three outcomes. The odds ratios (95% CIs) for DAPSA28 remission were: age, per year: 0.97 (0.96-0.98); disease duration, years (<2 years as reference): 2-3 years: 1.20 (0.89-1.60), 4-9 years: 1.42 (1.09-1.84), ≥10 years: 1.66 (1.26-2.20); men vs women: 1.85 (1.54-2.23); CRP of >10 vs ≤10 mg/l: 1.52 (1.22-1.89) and 1 mm increase in patient fatigue score: 0.99 (0.98-0.99). CONCLUSION Baseline predictors of remission, response and adherence to TNFi therapy were identified, of which five were common for all three outcomes, indicating that the predictors emerging from our pooled cohort may be considered generalizable from country level to disease level.
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Affiliation(s)
- Louise Linde
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Lykke M Ørnbjerg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Stylianos Georgiadis
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Simon H. Rasmussen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Michelsen
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Research Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali, University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department for Science and Research, Landspitali University Hospital, Reykjavik, Iceland
| | - Dan C Nordström
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Timo Yli-Kerttula
- Department of Rheumatology, Satakunta Central Hospital, Rauma, Finland
| | - Lucie Nekvindová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU and University of Cagliari, Monserrato, Italy
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- DANBIO Registry, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Burkhard Möller
- Department for Rheumatology and Immunology, Inselspital, University Hospital Bern, on behalf of the Swiss Clinical Quality Management for Rheumatic Diseases, SCQM, Zürich, Switzerland
| | - Marleen van de Sande
- Amsterdam UMC, University of Amsterdam, Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, The Netherlands
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Romanian Registry of Rheumatic Diseases, Bucharest, Romania
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Merih Birlik
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sukran Erten
- Department of Rheumatology, Ankara Yıldırım Beyazıt University Ankara City Hospital, Ankara, Turkey
| | - Maria J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Department of Rheumatology, Hospital de Santa Maria, CHULN, Instituto Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Merete L Hetland
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research (COPECARE), Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Thevathasan T, Gregers E, Rasalingam Mørk S, Degbeon S, Linde L, Bønding Andreasen J, Smerup M, Eifer Møller J, Hassager C, Laugesen H, Dreger H, Brand A, Balzer F, Landmesser U, Juhl Terkelsen C, Flensted Lassen J, Skurk C, Søholm H. Lactate and Lactate Clearance as Predictors of One-Year Survival in Extracorporeal Cardiopulmonary Resuscitation - An International, Multicentre Cohort Study. Resuscitation 2024:110149. [PMID: 38403182 DOI: 10.1016/j.resuscitation.2024.110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
AIM Extracorporeal cardiopulmonary resuscitation (ECPR) can be considered in selected patients with refractory cardiac arrest. Given the risk of patient futility and high resource utilisation, identifying ECPR candidates, who would benefit from this therapy, is crucial. Previous ECPR studies investigating lactate as a potential prognostic marker have been small and inconclusive. It was hypothesised that the lactate level (immediately prior to initiation of ECPR) and lactate clearance (within 24 hours after ECPR initiation) are predictors of one-year survival in a large, multicentre study cohort of ECPR patients. METHODS Adult patients with refractory cardiac arrest at three German and four Danish tertiary cardiac care centres between 2011 and 2021 were included. Pre-ECPR lactate and 24-hour lactate clearance were divided into three equally sized tertiles. Multivariable logistic regression analyses and Kaplan-Meier analyses were used to analyse survival outcomes. RESULTS 297 adult patients with refractory cardiac arrest were included in this study, of which 65 (22%) survived within one year. The pre-ECPR lactate level and 24-hour lactate clearance were level-dependently associated with one-year survival: OR 5.40 [95% CI 2.30-13.60] for lowest versus highest pre-ECPR lactate level and OR 0.25 [95% CI 0.09-0.68] for lowest versus highest 24-hour lactate clearance. Results were confirmed in Kaplan-Meier analyses (each p log rank <0.001) and subgroup analyses. CONCLUSION Pre-ECPR lactate levels and 24 hour-lactate clearance after ECPR initiation in patients with refractory cardiac arrest were level-dependently associated with one-year survival. Lactate is an easily accessible and quickly available point-of-care measurement which might be considered as an early prognostic marker when considering initiation or continuation of ECPR treatment.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany; Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Henryk Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anna Brand
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; The Danish Heart Foundation, Vognmagergade 7, 3rd floor, 1120 Copenhagen, Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 17, 5000 Odense, Denmark
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
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9
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Mieritz HB, Povlsen AL, Linde L, Beske RP, Helgestad OKL, Josiassen J, Hassager C, Schmidt H, Jensen LO, Holmvang L, Møller JE, Ravn HB. DIFFERENCES IN MANAGEMENT AND PROGNOSTICATION OF CARDIOGENIC SHOCK PATIENTS IN THE PRESENCE AND ABSENCE OF OUT-OF-HOSPITAL CARDIAC ARREST. Shock 2024; 61:209-214. [PMID: 38010103 DOI: 10.1097/shk.0000000000002272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT Background: The clinical spectrum of acute myocardial infarction complicated by cardiogenic shock (AMICS) varies. Out-of-hospital cardiac arrest (OHCA) can be the first sign of cardiac failure, whereas others present with various degrees of hemodynamic instability (non-OHCA). The aim of the present study was to explore differences in prehospital management and characteristics of survivors and nonsurvivors in AMICS patients with OHCA or non-OHCA. Methods: Data analysis was based on patient data from the RETROSHOCK cohort comprising consecutive AMICS patients admitted to two tertiary cardiac centers between 2010 and 2017. Results: 1,716 AMICS patients were included and 42% presented with OHCA. Mortality in OHCA patients was 47% versus 57% in the non-OHCA group. Almost all OHCA patients were intubated before admission (96%). In the non-OHCA group, prehospital intubation (25%) was associated with a better survival ( P < 0.001). Lactate level on admission demonstrated a linear relationship with mortality in OHCA patients. In non-OHCA, probability of death was higher for any given lactate level <12 mmol/L compared with OHCA. However, a lactate level >7 mmol/L in non-OHCA did not increase mortality odds any further. Conclusion: Mortality was almost doubled for any admission lactate level up to 7 mmol/L in non-OHCA patients. Above this level, mortality remained unchanged in non-OHCA patients but continued to increase in OHCA patients. Prehospital intubation was performed in almost all OHCA patients but only in one of four patients without OHCA. Early intubation in non-OHCA patients was associated with a better outcome.
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Affiliation(s)
- Hanne Beck Mieritz
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Amalie Ling Povlsen
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rasmus Paulin Beske
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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10
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Linde L, Ørnbjerg LM, Rasmussen SH, Love TJ, Loft AG, Závada J, Vencovský J, Laas K, Nordstrom D, Sokka-Isler T, Gudbjornsson B, Gröndal G, Iannone F, Ramonda R, Hellamand P, Kristianslund EK, Kvien TK, Rodrigues AM, Santos MJ, Codreanu C, Rotar Z, Tomšič M, Castrejon I, Díaz-Gonzáles F, Di Giuseppe D, Ljung L, Nissen MJ, Ciurea A, Macfarlane GJ, Heddle M, Glintborg B, Østergaard M, Hetland ML. Commonalities and differences in set-up and data collection across European spondyloarthritis registries - results from the EuroSpA collaboration. Arthritis Res Ther 2023; 25:205. [PMID: 37858143 PMCID: PMC10585911 DOI: 10.1186/s13075-023-03184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In European axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) clinical registries, we aimed to investigate commonalities and differences in (1) set-up, clinical data collection; (2) data availability and completeness; and (3) wording, recall period, and scale used for selected patient-reported outcome measures (PROMs). METHODS Data was obtained as part of the EuroSpA Research Collaboration Network and consisted of (1) an online survey and follow-up interview, (2) upload of real-world data, and (3) selected PROMs included in the online survey. RESULTS Fifteen registries participated, contributing 33,948 patients (axSpA: 21,330 (63%), PsA: 12,618 (37%)). The reported coverage of eligible patients ranged from 0.5 to 100%. Information on age, sex, biological/targeted synthetic disease-modifying anti-rheumatic drug treatment, disease duration, and C-reactive protein was available in all registries with data completeness between 85% and 100%. All PROMs (Bath Ankylosing Spondylitis Disease Activity and Functional Indices, Health Assessment Questionnaire, and patient global, pain and fatigue assessments) were more complete after 2015 (68-86%) compared to prior (50-79%). Patient global, pain and fatigue assessments showed heterogeneity between registries in terms of wording, recall periods, and scale. CONCLUSION Important heterogeneity in registry design and data collection across fifteen European axSpA and PsA registries was observed. Several core measures were widely available, and an increase in data completeness of PROMs in recent years was identified. This study might serve as a basis for examining how differences in data collection across registries may impact the results of collaborative research in the future.
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Affiliation(s)
- Louise Linde
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark.
| | - Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakub Závada
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Dan Nordstrom
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | | | | | - Gerdur Gröndal
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Pasoon Hellamand
- Department of Clinical Immunology and Rheumatology, Amsterdam Medical Center, Amsterdam, Netherlands
| | - Eirik K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Ana M Rodrigues
- Sociedade Portuguesa de Reumatologia, Reuma.pt, Lisbon, Portugal
| | - Maria J Santos
- Department of Rheumatology, Hospital Garcia de Orta, Almada, Lisbon, Portugal
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Bucharest, Romania
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Isabel Castrejon
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Ljung
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Maureen Heddle
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, DANBIO Registry, Rigshospitalet, Glostrup, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
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11
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Linde L, Ørnbjerg LM, Brahe CH, Wallman JK, Di Giuseppe D, Závada J, Castrejon I, Díaz-Gonzalez F, Rotar Z, Tomšič M, Glintborg B, Gudbjornsson B, Geirsson AJ, Michelsen B, Kristianslund EK, Santos MJ, Barcelos A, Nordström D, Eklund KK, Ciurea A, Nissen M, Akar S, Hyldstrup LH, Krogh NS, Hetland ML, Østergaard M. Second and third TNF inhibitors in European patients with axial spondyloarthritis: Effectiveness and impact of the reason for switching. Rheumatology (Oxford) 2023:kead494. [PMID: 37738257 DOI: 10.1093/rheumatology/kead494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To investigate real-world effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA) and the association with 1) treatment line (second and third TNFi-series) and 2) reason for withdrawal from the preceding TNFi (lack of efficacy (LOE) versus adverse events (AE)). METHODS Prospectively collected routine care data from 12 European registries were pooled. Rates for 12-month drug retention and 6-month remission (Ankylosing Spondylitis Disease Activity Score C-reactive protein inactive disease (ASDAS-ID)) were assessed in second and third TNFi-series and stratified by withdrawal reason. RESULTS We included 8254 s and 2939 third TNFi-series; 12-month drug retention rates were similar (71%). Six-month ASDAS-ID rates were higher for the second (23%) than third TNFi (16%). Twelve-month drug retention rates for patients withdrawing from the preceding TNFi due to AE versus LOE were similar for the second (68% and 67%) and third TNFi (both 68%), while for the second TNFi, rates were lower in primary than secondary non-responders (LOE < 26 versus ≥26 weeks) (58% versus 71%, p< 0.001). Six-month ASDAS-ID rates for the second TNFi were higher if the withdrawal reason was AE (27%) versus LOE (17%), p< 0.001, while similar for the third TNFi (19% versus 13%, p= 0.20). CONCLUSION A similar proportion of axSpA patients remained on a second and third TNFi after one year, but with low remission rates for the third TNFi. Remission rates on the second TNFi (but not the third) were higher if the withdrawal reason from the preceding TNFi was AE versus LOE.
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Affiliation(s)
- Louise Linde
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lykke Midtbøll Ørnbjerg
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Cecilie Heegaard Brahe
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | - Johan Karlsson Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jakub Závada
- Institute of Rheumatology and Department of Rheumatology, 1 Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Isabel Castrejon
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Federico Díaz-Gonzalez
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna and Rheumatology Service, Hospital Universitario de Canarias, La Laguna, Spain
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bente Glintborg
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
- DANBIO Registry, Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO), Landspitali University Hospital, Reykjavik, Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Brigitte Michelsen
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Research Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Eirik Klami Kristianslund
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Maria José Santos
- Department of Rheumatology, Hospital Garcia de Orta, Almada and Instituto Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Reuma.pt registry
| | - Anabela Barcelos
- Department of Rheumatology, Centro Hospitalar do Baixo Vouga, Aveiro and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa. Lisbon, Portugal: Reuma.pt registry
| | - Dan Nordström
- Departments of Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Kari K Eklund
- Inflammation Center, Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Servet Akar
- School of Medicine, Department of Internal Medicine, Division of Rheumatology, Izmir Katip Celebi University, Izmir, Turkey
| | - Lise Hejl Hyldstrup
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
| | | | - Merete Lund Hetland
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen Center for Arthritis Research (COPECARE), Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Schreiber K, Giles I, Costedoat-Chalumeau N, Nelson-Piercy C, Dolhain RJ, Mosca M, Förger F, Fischer-Betz R, Molto A, Tincani A, Pasquier E, Marin B, Elefant E, Salmon J, Bermas BL, Sammaritano L, Clowse MEB, Chambers C, Buyon J, Inoue SA, Agmon-Levin N, Aguilera S, Emadi SA, Andersen J, Andrade D, Antovic A, Arnaud L, Christiansen AA, Avcin T, Badreh-Wirström S, Bertsias G, Bini I, Bobirca A, Branch W, Brucato A, Bultink I, Capela S, Cecchi I, Cervera R, Chighizola C, Cobilinschi C, Cuadrado MJ, Dey D, Etomi O, Espinosa G, Flint J, Fonseca JE, Fritsch-Stork R, Gerosa M, Glintborg B, Skorpen CG, Goulden B, Graversgaard C, Gunnarsson I, Gupta L, Hetland M, Hodson K, Hunt BJ, Isenberg D, Jacobsen S, Khamashta M, Levy R, Linde L, Lykke J, Meissner Y, Moore L, Morand E, Navarra S, Opris-Belinski D, Østensen M, Ozawa H, Perez-Garcia LF, Petri M, Pons-Estel GJ, Radin M, Raio L, Rottenstreich A, Ruiz-Irastorza G, Tunjić SR, Rygg M, Sciascia S, Strangfeld A, Svenungsson E, Tektonidou M, Troldborg A, Vinet E, Vojinovic J, Voss A, Wallenius M, Andreoli L. Global comment on the use of hydroxychloroquine during the periconception period and pregnancy in women with autoimmune diseases. Lancet Rheumatol 2023; 5:e501-e506. [PMID: 38251494 DOI: 10.1016/s2665-9913(23)00215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Karen Schreiber
- Danish Centre for Expertise in Rheumatology (CeViG), Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark (KS); Institute for Regional Health, Southern Danish University, Odense, Denmark.
| | - Ian Giles
- Centre for Rheumatology, UCL Division of Medicine, London, UK
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France; Université Paris Cité, Paris, France
| | - Catherine Nelson-Piercy
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK (CN-P, OE)
| | - Radboud Jem Dolhain
- Erasmus MC, University Medical Centre, Department of Rheumatology, Rotterdam, Netherlands
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland
| | - Rebecca Fischer-Betz
- Department for Rheumatology and Hiller Research Institute, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Molto
- Rheumatology Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST-Spedali Civili and University, Brescia, Italy
| | - Elisabeth Pasquier
- Département de Médecine Interne et Pneumologie, CHRU de Brest, Hôpital de la Cavale Blanche, Brest, France; INSERM, Centre d'Investigation Clinique 1412, CHRU de Brest, Brest, France
| | - Benoit Marin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes, F75012, Paris, France
| | - Elisabeth Elefant
- AP-HP, Sorbonne Université, Hôpital Trousseau, Département de Santé Publique, Centre de Référence sur les Agents Tératogènes, F75012, Paris, France
| | - Jane Salmon
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA
| | | | - Lisa Sammaritano
- Weill Cornell Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Megan E B Clowse
- Division of Rheumatology and Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina Chambers
- Department of Paediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Jill Buyon
- Division of Rheumatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Saori Abe Inoue
- Department of Rheumatology, Institute of Medicine, University of Tsukuba, Japan
| | - Nancy Agmon-Levin
- The Zabludowicz Centre for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Aleksandra Antovic
- Department of Medicine, Division of Rheumatology Karolinska Institutet and Rheumatology, Karolinska University Hospital Stockholm, Sweden
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Centre National de Références Maladies Auto-Immunes, Strasbourg, France
| | - Alice Ashouri Christiansen
- Danish Center for Expertise in Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Badreh-Wirström
- Senior European and Regulatory Affairs Project Manager, EULAR PARE, Brussels, Belgium
| | - George Bertsias
- Rheumatology, University of Crete School of Medicine, Iraklio, Greece; Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Greece
| | | | - Anca Bobirca
- Department of Internal Medicine and Rheumatology, Dr I Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ware Branch
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milano, Fatebenefratelli Hospital, Milano, Italy
| | - Irene Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Centre, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Susanna Capela
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Irene Cecchi
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Cecilia Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Paediatric Rheumatology Unit, ASST Pini, CTO, Milan, Italy
| | - Claudia Cobilinschi
- Department of Internal Medicine and Rheumatology Sânta Maria Clinical Hospital, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Dzifa Dey
- Rheumatology Unit, Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, University of Ghana Medical School, Accra, Ghana
| | - Oseme Etomi
- Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK (CN-P, OE)
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Julia Flint
- Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - João-Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa and Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ruth Fritsch-Stork
- Health Care Centre Mariahilf, ÖGK and Rheumatology Department at the Sigmund Freud Private University, Vienna, Austria
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Centre for Adult and Paediatric Rheumatic Diseases, University of Milan, Milan, Italy; Clinical Rheumatology Unit, ASST G Pini and CTO, Milan, Italy
| | - Bente Glintborg
- DANBIO and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Carina Gøtestam Skorpen
- Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway; Department of Rheumatology Ålesund, Helse More og Romsdal, Ålesund, Norway
| | - Bethan Goulden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Rheumatology Research, UCL Division of Medicine, University College London, London; Women's Health, University College London Hospital, London, UK
| | - Christine Graversgaard
- Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark; Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Iva Gunnarsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden; Solna and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Merete Hetland
- DANBIO and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ken Hodson
- UK Teratology Information Service, Newcastle upon Tyne, UK
| | - Beverley J Hunt
- Thrombosis and Haemophilia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Isenberg
- Centre for Rheumatology, UCL Division of Medicine, London, UK
| | - Søren Jacobsen
- Copenhagen Research Centre for Autoimmune Connective Tissue Diseases, COPEACT, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Louise Linde
- Copenhagen Research Centre for Autoimmune Connective Tissue Diseases, Lupus and Vasculitis Clinic, Copenhagen university hospital, Rigshospitalet, Denmark
| | - Jacob Lykke
- Department of Obstetrics, Copenhagen university hospital, Rigshospitalet, Denmark
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
| | - Louise Moore
- Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland
| | - Eric Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra Navarra
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Daniela Opris-Belinski
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines; Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monika Østensen
- Department of Rheumatology, Sorlandet Hospital Kristiansand, Kristiansand, Norway (MØ)
| | - Hiroki Ozawa
- Immuno-Rheumatology Centre, St Luke's International Hospital, Tokyo, Japan
| | | | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Massimo Radin
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Amihai Rottenstreich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra and Northwell, New York, NY, USA; Laboratory of Blood and Vascular Biology, Rockefeller University, New York, NY, USA; Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, University of the Basque Country, Bizkaia, Spain
| | | | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, University of Turin, San Giovanni Hospital, Turin, Italy
| | - Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Elisabet Svenungsson
- Department of Medicine, Division of Rheumatology, Karolinska Institutet, Solna and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Tektonidou
- First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anne Troldborg
- Department of Rheumatology, Aarhus University Hospital, and Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Evelyne Vinet
- McGill University, McGill University Health Centre, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jelena Vojinovic
- University of Nis, Faculty of Medicine, Clinic for Pediatrics University Clinical Center Nis, Nis, Serbia
| | - Anne Voss
- Department of Rheumatology C, Odense University Hospital, Odense, Denmark
| | - Marianne Wallenius
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, Department of Rheumatology, Trondheim University Hospital, St Olavs Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, Rheumatology and Clinical Immunology Unit, Spedali Civili and University of Brescia, Brescia, Italy
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Linde L, Faurschou M, Krintel SB, Baslund B. Response to Treatment With Tofacitinib in 11 Patients With Refractory Granulomatosis With Polyangiitis. J Rheumatol 2023:jrheum.221219. [PMID: 36921971 DOI: 10.3899/jrheum.221219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody-associated vasculitis that affects mainly small-sized vessels and is characterized by upper and lower respiratory tract, kidney, eye, skin, and neurologic involvement.
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Affiliation(s)
- Louise Linde
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Mikkel Faurschou
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Sophine Boysen Krintel
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bo Baslund
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
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Frederiksen PH, Josiassen J, Udesen NLJ, Linde L, Helgestad OK, Banke A, Jensen LO, Schmidt H, Hassager C, Ravn HB, Møller JE. Impact of Impella RP Versus Vasoactive Treatment on Right and Left Ventricular Strain in a Porcine Model of Acute Cardiogenic Shock Induced by Right Coronary Artery Embolization. J Am Heart Assoc 2023; 12:e8126. [PMID: 36734350 PMCID: PMC9973621 DOI: 10.1161/jaha.122.027831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 02/04/2023]
Abstract
Background The response of the left ventricle to cardiogenic shock (CS) caused by right ventricular (RV) infarction and the effect of treatment with either vasoactive treatment or Impella RP are not well described. We sought to determine RV and left ventricular longitudinal strain (LS) by echocardiography after initiation of either Impella RP or vasoactive treatment for CS induced by right coronary artery embolization. Methods and Results CS was induced with microsphere embolization in the right coronary artery in 20 pigs. Shock was defined as a reduction in cardiac output of ≥50% and/or an SvO2 <30%. At the time of CS either Impella RP or vasoactive treatment (norepinephrine and milrinone) was initiated. Echocardiography and conductance measures were obtained at baseline, when CS was present, and 30, 90, and 180 minutes after induction of CS. Of 20 animals, 14 completed the protocol and were treated with either vasoactive treatment (n=7) or Impella RP (n=7); 6 animals died (3 in each group). In the RV there was a significantly higher LS with the vasoactive treatment compared with Impella RP (-7.6% [4.5] to -6.0% [5.2] vs -4.5% [6.6] to -14.2% [10.6]; P<0.006). Left ventricular LS improved with both treatments compared with shock, but with a larger effect (-9.4% [3.2] to -17.9% [3.6]) on LS with vasoactive treatment than Impella RP (-9.8% [3.1] to -12.3% [4.6]; P<0.001). We found a significant correlation between stroke work and RV LS (r=-0.60, P<0.001) and left ventricular LS (r=-0.62, P<0.001). Conclusions We found significantly higher hemodynamic effects with vasoactive treatment compared with Impella RP in both the RV and left ventricular but at a cost of increased stroke work.
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Affiliation(s)
- Peter H. Frederiksen
- Department of CardiologyOdense University HospitalOdenseDenmark
- Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
| | - Jakob Josiassen
- Department of Cardiology, Heart CenterCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | | | - Louise Linde
- Department of CardiologyOdense University HospitalOdenseDenmark
| | | | - Ann Banke
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Lisette O. Jensen
- Department of CardiologyOdense University HospitalOdenseDenmark
- Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
| | - Henrik Schmidt
- Department of Cardiothoracic AnaesthesiologyOdense University HospitalOdenseDenmark
| | - Christian Hassager
- Department of Cardiology, Heart CenterCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Hanne B. Ravn
- Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
- Department of Cardiothoracic AnaesthesiologyOdense University HospitalOdenseDenmark
| | - Jacob E. Møller
- Department of CardiologyOdense University HospitalOdenseDenmark
- Faculty of Health SciencesUniversity of Southern DenmarkOdenseDenmark
- Department of Cardiology, Heart CenterCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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15
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Linde L, Mørk SR, Gregers E, Andreasen JB, Lassen JF, Ravn HB, Schmidt H, Riber LP, Thomassen SA, Laugesen H, Eiskjær H, Terkelsen CJ, Christensen S, Tang M, Moeller-Soerensen H, Holmvang L, Kjaergaard J, Hassager C, Moller JE. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest. Heart 2023; 109:216-222. [PMID: 36371665 PMCID: PMC9872231 DOI: 10.1136/heartjnl-2022-321405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/12/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To describe characteristics of patients admitted with refractory cardiac arrest for possible extracorporeal cardiopulmonary resuscitation (ECPR) and gain insight into the reasons for refraining from treatment in some. METHODS Nationwide retrospective cohort study involving all tertiary centres providing ECPR in Denmark. Consecutive patients admitted with ongoing chest compression for evaluation for ECPR treatment were enrolled. Presenting characteristics, duration of no-flow and low-flow time, end-tidal carbon dioxide (ETCO2), lactate and pH, and recording of reasons for refraining from ECPR documented by the treating team were recorded. Outcomes were survival to intensive care unit admission and survival to hospital discharge. RESULTS Of 579 patients admitted with refractory cardiac arrest for possible ECPR, 221 patients (38%) proceeded to ECPR and 358 patients (62%) were not considered candidates. Median prehospital low-flow time was 70 min (IQR 56 to 85) in ECPR patients and 62 min (48 to 81) in no-ECPR patients, p<0.001. Intra-arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. The leading causes for not initiating ECPR stated by the treating team were duration of low-flow time in 39%, severe metabolic derangement in 35%, and in 31% low ETCO2. The prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or prehospital low-flow time combined with low ETCO2. Survival to discharge was only achieved in six patients (1.7%) in the no-ECPR group. CONCLUSIONS In this large nationwide study of patients admitted for possible ECPR, two-thirds of patients were not treated with ECPR. The most frequent reasons to abstain from ECPR were long duration of prehospital low-flow time, metabolic derangement and low ETCO2.
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Affiliation(s)
- Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Sisse Anette Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Steffen Christensen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark,Department Clinical Medicine, Copenhagen University, Kobenhavn, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark,Department Clinical Medicine, Copenhagen University, Kobenhavn, Denmark
| | - Jacob Eifer Moller
- Department of Cardiology, Odense University Hospital, Odense, Denmark .,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Kobenhavn, Denmark
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Ørnbjerg LM, Linde L, Georgiadis S, Rasmussen SH, Lindström U, Askling J, Michelsen B, Giuseppe DD, Wallman JK, Pavelka K, Závada J, Nissen MJ, Jones GT, Relas H, Pirilä L, Tomšič M, Rotar Z, Geirsson AJ, Gudbjornsson B, Kristianslund EK, van der Horst-Bruinsma I, Loft AG, Laas K, Iannone F, Corrado A, Ciurea A, Santos MJ, Santos H, Codreanu C, Akkoc N, Gunduz OS, Glintborg B, Østergaard M, Hetland ML. Corrigendum to 'Predictors of ASDAS-CRP inactive disease in axial spondyloarthritis during treatment with TNF-inhibitors: data from the EuroSpA collaboration' [Seminars in Arthritis and Rheumatism 56 (2022) 1-13/152081]. Semin Arthritis Rheum 2023; 58:152141. [PMID: 36463635 DOI: 10.1016/j.semarthrit.2022.152141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark
| | - Louise Linde
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark.
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark
| | - Simon H Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Brigitte Michelsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway; Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan K Wallman
- Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Závada
- Institute of Rheumatology, Prague, Czech Republic; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michael J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Heikki Relas
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Pirilä
- Center for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland; Department of Internal Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ziga Rotar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, Landspitali, University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Karin Laas
- Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
| | | | - Addolorata Corrado
- Rheumatology Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maria J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal; Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Helena Santos
- Reuma.pt, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal; Instituto Português de Reumatologia, Lisbon, Portugal; EpiDoc Unit, Nova Medical School, Lisbon, Portugal
| | - Catalin Codreanu
- Center for Rheumatic Diseases, University of Medicine and Pharmacy, Romanian Registry of Rheumatic Diseases, Bucharest, Romania
| | - Nurullah Akkoc
- Division of Rheumatology, Department of Medicine, Celal Bayar University Hospital, Manisa Turkey
| | - Ozgul S Gunduz
- Division of Rheumatology, Department of Medicine, Celal Bayar University Hospital, Manisa Turkey
| | - Bente Glintborg
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; DANBIO registry, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gregers E, Mørk SR, Linde L, Andreasen JB, Smerup M, Kjærgaard J, Møller-Sørensen PH, Holmvang L, Christensen S, Terkelsen CJ, Tang M, Møller JE, Lassen JF, Schmidt H, Riber LP, Winther-Jensen M, Thomassen S, Laugesen H, Hassager C, Søholm H. Extracorporeal cardiopulmonary resuscitation: a national study on the association between favourable neurological status and biomarkers of hypoperfusion, inflammation, and organ injury. European Heart Journal. Acute Cardiovascular Care 2022; 11:808-817. [DOI: 10.1093/ehjacc/zuac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Aims
In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischaemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR). We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.
Methods and results
This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011–2020). Biomarkers the first days after ECPR-initiation were assessed. Odds ratio of favourable neurological status (Cerebral Performance Category 1–2) at hospital discharge was estimated by logistic regression analyses. Cut-off values were calculated using the Youden’s index. Fifty-six patients (25%) survived to hospital discharge, 51 (91%) with a favourable neurological status. Factors independently associated with favourable neurological status were low flow time <81 min, admission leukocytes ≥12.8 × 109/L, admission lactate <13.2 mmol/L, alkaline phosphatase (ALP) < 56 (day1) or <55 U/L (day2), and day 1 creatine kinase MB (CK-MB) < 500 ng/mL. Selected biomarkers (leukocytes, C-reactive protein, and lactate) were significantly better predictors of favourable neurological status than classic OHCA-variables (sex, age, low-flow time, witnessed arrest, shockable rhythm) alone (P = 0.001) after hospital admission.
Conclusion
Biomarkers of hypoperfusion (lactate), inflammation (leucocytes), and organ injury (ALP and CK-MB) were independently associated with neurological status at hospital discharge. Biomarkers of hypoperfusion and inflammation (at hospital admission) and organ injury (days 1 and 2 after ECPR) may aid in the clinical decision of when to prolong or terminate ECPR in cases of refractory OHCA.
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Affiliation(s)
- Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Jo Bønding Andreasen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Peter Hasse Møller-Sørensen
- Department of Cardiothoracic Anesthesiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Steffen Christensen
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
- The Danish Heart Foundation , Vognmagergade 7, 3. sal, 1120 Copenhagen K , Denmark
| | - Mariann Tang
- Department of Clinical Medicine, Aarhus University , Palle Juul-Jensens Boulevard 11, 8200 Aarhus N , Denmark
- Department of Cardiothoracic Surgery, Aarhus University Hospital , Palle Juul-Jensens Boulevard 99, 8200 Aarhus N , Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
- Department of Clinical Research, University of Southern Denmark , J. B. Winsløws Vej 19, 3, 5000 Odense C , Denmark
| | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
- Department of Clinical Research, University of Southern Denmark , J. B. Winsløws Vej 19, 3, 5000 Odense C , Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Lars Peter Riber
- Department of Cardiothoracic Surgery, Odense University Hospital , J. B. Winsløws Vej 4, 5000 Odense C , Denmark
| | - Matilde Winther-Jensen
- Section for Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Frederiksberg Hospital , Nordre Fasanvej 57, Indgang 5 (bygning 41), 2000 Frederiksberg , Denmark
| | - Sisse Thomassen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Helle Laugesen
- Department of Anesthesiology and Intensive Care, Aalborg University Hospital , Hobrovej 18-22, 9000 Aalborg , Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Clinical Medicine, University of Copenhagen , Blegdamsvej 3, 2200 Copenhagen N , Denmark
| | - Helle Søholm
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet , Blegdamsvej 9, 2100 Copenhagen OE , Denmark
- Department of Cardiology, Zealand University Hospital Roskilde , Sygehusvej 10, 4000 Roskilde , Denmark
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Gregers E, Moerk SR, Linde L, Andreasen JB, Smerup M, Kjaergaard J, Moeller-Soerensen PH, Holmvang L, Christensen S, Terkelsen CJ, Moeller JE, Lassen JF, Rieber LP, Laugesen H, Soeholm H. Extracorporeal cardiopulmonary resuscitation: a national study on the association between survival and biomarkers of hypoperfusion, inflammation, and organ failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In refractory out-of-hospital cardiac arrest (OHCA) with prolonged whole-body ischemia, global tissue injury proceeds even after establishment of circulation with extracorporeal cardiopulmonary resuscitation (ECPR).
Purpose
We aimed to investigate the role of biomarkers reflecting hypoperfusion, inflammation, and organ injury in prognostication of patients with refractory OHCA managed with ECPR.
Methods
This nationwide retrospective study included 226 adults with refractory OHCA managed with ECPR in Denmark (2011–2020). Biomarkers at admission and consecutively two days after ECPR initiation were retrieved. Odds ratio (OR) of 90-day survival were assessed by logistic regression analyses. Cut-off values were calculated from area under the curve (AUC) via the Youden index.
Results
Fifty-six patients (25%) survived to hospital discharge, all were still alive after 90-days and 91% had a favorable neurological status at discharge. Factors independently associated with 90-day survival were: male sex, shockable presenting rhythm, low flow time, platelets, pH, lactate, C-reactive protein, lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and creatine kinase MB (CK-MB) level. Comparing the ability of standard predictive variables (age, sex, shockable presenting rhythm, witnessed arrest, and low flow time) and selected biomarkers (from multivariate analyses) in predicting 90-day survival, biomarkers day 2 after OHCA were significantly better than standard variables (AUC 0.79 vs. 0.56, p=0.01).
Conclusion
Biomarkers of hypoperfusion (low lactate and high pH), inflammation (high platelets and CRP), and organ failure (low LDH, ALP, and CK-MB) were independently associated with 90-day survival. Biomarkers on day 2 after OHCA (d-dimer, ALP, and CK-MB) were more predictive of 90-day survival than standard predictive variables.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Odense University Hospital's and Rigshospitalet's Common Research Foundation
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Affiliation(s)
- E Gregers
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - S R Moerk
- Aarhus University Hospital , Aarhus , Denmark
| | - L Linde
- Odense University Hospital , Odense , Denmark
| | | | - M Smerup
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - L Holmvang
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | | | - J E Moeller
- Odense University Hospital , Odense , Denmark
| | - J F Lassen
- Odense University Hospital , Odense , Denmark
| | - L P Rieber
- Odense University Hospital , Odense , Denmark
| | - H Laugesen
- Aalborg University Hospital , Aalborg , Denmark
| | - H Soeholm
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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Linde L, Moerk SR, Gregers E, Andreasen JB, Lassen JF, Ravn HB, Schmidt H, Riber LP, Laugesen H, Terkelsen CJ, Moeller-Soerensen PH, Holmvang L, Kjaergaard J, Hassager C, Moeller JE. Selection of patients for mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) is a potential salvage therapy for selected patients with refractory out-of-hospital cardiac arrest (OHCA).
Purpose
The objective of this study was to describe the characteristics of potential ECPR patients.
Methods
This retrospective, observational cohort study included 579 patients admitted with refractory OHCA for possible ECPR at all tertiary cardiac arrest centers in Denmark between 2015 and 2020. Presenting characteristics, reasons for refraining from ECPR, and survival to hospital discharge were recorded.
Results
After initial evaluation, 221 patients (38%) proceeded to ECPR, and 358 (62%) were considered futile. Median prehospital low-flow time was 70 minutes [interquartile range 56–85] in ECPR patients and 62 minutes [48–81] in no-ECPR patients, p<0.001. Intra arrest transport was more than 50 km in 92 (42%) ECPR patients and 135 in no-ECPR patients (38%), p=0.25. Treatment decision was taken by a team of three specialists in 513 cases (97%). The leading cause for not initiating ECPR was duration of low flow time (39%). Severe metabolic derangement and low end-tidal CO2 (ETCO2) were contributing factors in 35% and 31%, respectively, Figure 1. 83% of the patients had two or more contributing factors recorded as reasons for not initiating ECPR, Figure 2. The most prevailing combination of contributing factors were non-shockable rhythm, low ETCO2, and metabolic derangement or duration of prehospital low flow time combined with low ETCO2. Survival to discharge was achieved in six patients (1.7%) in the no-ECPR group and 50 (23%) in the ECPR group.
Conclusions
In this large nationwide study of patients admitted for possible ECPR, 62% were not treated with ECPR. The most frequent reasons to abstain from ECPR were duration of prehospital low flow time, metabolic derangement, and low ETCO2.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation
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Affiliation(s)
- L Linde
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - S R Moerk
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - E Gregers
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J B Andreasen
- Aalborg University Hospital, Department of Anesthesiology and Intensive Care , Aalborg , Denmark
| | - J F Lassen
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - H B Ravn
- Odense University Hospital, Department of Anaesthesiology and Intensive Care , Odense , Denmark
| | - H Schmidt
- Odense University Hospital, Department of Anaesthesiology and Intensive Care , Odense , Denmark
| | - L P Riber
- Odense University Hospital, Department of Thoracic and Vascular Surgery , Odense , Denmark
| | - H Laugesen
- Aalborg University Hospital, Department of Anesthesiology and Intensive Care , Aalborg , Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - P H Moeller-Soerensen
- Copenhagen University Hospital, Cardiothoracic Anesthesiology , Copenhagen , Denmark
| | - L Holmvang
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Kjaergaard
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Hassager
- Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology , Odense , Denmark
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Udesen NLJ, Helgestad OKL, Josiassen J, Hassager C, Højgaard HF, Linde L, Kjaergaard J, Holmvang L, Jensen LO, Schmidt H, Ravn HB, Møller JE. Vasoactive pharmacological management according to SCAI class in patients with acute myocardial infarction and cardiogenic shock. PLoS One 2022; 17:e0272279. [PMID: 35925990 PMCID: PMC9352108 DOI: 10.1371/journal.pone.0272279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Vasoactive treatment is a cornerstone in treating hypoperfusion in cardiogenic shock following acute myocardial infarction (AMICS). The purpose was to compare the achievement of treatment targets and outcome in relation to vasoactive strategy in AMICS patients stratified according to the Society of Cardiovascular Angiography and Interventions (SCAI) shock classification. Methods Retrospective analysis of patients with AMICS admitted to cardiac intensive care unit at two tertiary cardiac centers during 2010–2017 with retrieval of real-time hemodynamic data and dosages of vasoactive drugs from intensive care unit databases. Results Out of 1,249 AMICS patients classified into SCAI class C, D, and E, mortality increased for each shock stage from 34% to 60%, and 82% (p<0.001). Treatment targets of mean arterial blood pressure > 65mmHg and venous oxygen saturation > 55% were reached in the majority of patients; however, more patients in SCAI class D and E had values below treatment targets within 24 hours (p<0.001) despite higher vasoactive load and increased use of epinephrine for each severity stage (p<0.001). In univariate analysis no significant difference in mortality within SCAI class D and E regarding vasoactive strategy was observed, however in SCAI class C, epinephrine was associated with higher mortality and a significantly higher vasoactive load to reach treatment targets. In multivariate analysis there was no statistically association between individually vasoactive choice within each SCAI class and 30-day mortality. Conclusion Hemodynamic treatment targets were achieved in most patients at the expense of increased vasoactive load and more frequent use of epinephrine for each shock severity stage. Mortality was high regardless of vasoactive strategy; only in SCAI class C, epinephrine was associated with a significantly higher mortality, but the signal was not significant in adjusted analysis.
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Affiliation(s)
| | | | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Henrik Schmidt
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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21
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Ratcovich HL, Josiassen J, Helgestad OKL, Linde L, Jensen LO, Ravn HB, Joshi FR, Engstrøm T, Schmidt H, Hassager C, Møller JE, Holmvang L. Outcome in Elderly Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction. Shock 2022; 57:327-335. [PMID: 34265831 DOI: 10.1097/shk.0000000000001837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite advances in treatment of patients with cardiogenic shock following acute myocardial infarction (AMICS) in-hospital mortality remains around 50%. Outcome varies among patient subsets and the elderly often have a poor a priori prognosis. We sought to investigate outcome among elderly AMICS patients referred to evaluation and treatment at a tertiary university hospital. METHODS Current analysis was based on the RETROSHOCK registry comprising consecutive AMICS patients admitted to tertiary care. Patients in the registry were individually identified and validated. RESULTS Of 1,716 admitted patients, 496 (28.9%) patients were ≥75 years old. Older patients were less likely to be admitted directly to a tertiary centre (59.4% vs. 69.9%, P = 0.003), receive mechanical support devices (i.e., Impella® (8.9% vs. 15.0%, P = 0.003), and undergo revascularization attempt (76.8% vs. 90.2%, P < 0.001). Thirty-day survivors ≥75 years were characterized by having higher left ventricular ejection fraction (30.2% ± 12.5% vs. 26.5% ± 11.8%, P = 0.004) and lower arterial lactate (3.2[2.2-5.2] mmol/L vs. 5.5[3.3-8.2] mmol/L, P < 0.001) at admission. In a multivariable analysis of patients ≥75 years, higher age (HR 1.09, 95% CI 1.05-1.14, P < 0.001), higher heart rate (HR 1.01, 95% CI 1.001-1.014, P = 0.03), and higher lactate (HR 1.11, 95% CI 1.07-1.16, P < 0.001) at admission were associated with an increased risk of 30-day mortality. CONCLUSION Among patients ≥75 years with AMICS referred for tertiary specialized treatment, 30-day mortality was 73.4%. Survivors were characterized by lower arterial lactate and heart rate at admission.
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Affiliation(s)
- Hanna Louise Ratcovich
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ole Kristian Lerche Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Berg Ravn
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Francis R Joshi
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anesthesia, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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22
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Moerk SR, Stengaard C, Linde L, Moller JE, Andreasen JB, Laugesen H, Thomassen SA, Freeman PM, Christensen S, Tang M, Gregers E, Kjaergaard J, Hassager C, Eiskjaer H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking.
Purpose
To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome.
Methods
Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality.
Results
A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow <100 minutes, pH >6.8 and lactate <15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH <6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels >15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p<0.001)
Conclusion
A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensusSigns of life during CPR
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Affiliation(s)
- S R Moerk
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C Stengaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Linde
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J B Andreasen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - H Laugesen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - S A Thomassen
- Aalborg University Hospital, Department of Anaestesiology and Intensive Care, Aalborg, Denmark
| | - P M Freeman
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S Christensen
- Aarhus University Hospital, Department of Anaesthesiology and Intensive Care, Aarhus, Denmark
| | - M Tang
- Aarhus University Hospital, Department of Thoracic and Vascular Surgery, Aarhus, Denmark
| | - E Gregers
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Kjaergaard
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Hassager
- Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - H Eiskjaer
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - C J Terkelsen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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23
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Linde L, Carter-Storch R, Christensen NL, Øvrehus KA, Diederichsen ACP, Laursen K, Jensen PS, Rasmussen LM, Møller JE, Dahl JS. Sex differences in aortic valve calcification in severe aortic valve stenosis: association between computer tomography assessed calcification and valvular calcium concentrations. Eur Heart J Cardiovasc Imaging 2021; 22:581-588. [PMID: 32500142 DOI: 10.1093/ehjci/jeaa096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/17/2020] [Accepted: 04/16/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS The aims of this study were to investigate the correlation and sex differences between total valve calcium, valve calcium concentration, and aortic valve calcification (AVC) in explanted valves from patients with severe aortic valve stenosis undergoing aortic valve replacement (AVR). METHODS AND RESULTS Sixty-nine patients with severe aortic stenosis (AS) scheduled for elective AVR underwent echocardiography and cardiac computed tomography (CT) prior to surgery (AVCin vivo) and CT of the explanted aortic valve (AVCex vivo). Explanted valves were prepared in acid solution, sonicated, and analysed with Arsenazo III dye to estimate total valve calcium and valve calcium concentration. Median AVCex vivo was 2082 (1421-2973) AU; mean valve calcium concentration was 1.43 ± 0.42 µmol Ca2+/mg tissue; median total valve calcium 156 (111-255) mg Ca2+, and valve calcium density 52 (35-81) mg/cm2. AVC displayed a strong correlation with total valve calcium (R2 = 0.98, P < 0.001) and a moderate correlation with valve calcium concentration (R2 = 0.62, P < 0.001). Valvular calcium concentration was associated with sex, aortic valve area, and mean gradient. After adjusting for age and estimated glomerular filtration rate, sex and mean gradient remained associated with valve calcium concentrations. CONCLUSION AVC score provides a strong estimate for total valve calcium but to a lesser degree calcium concentration in the valve tissue of patients with severe AS. Females presented lower valvular calcium concentrations than males irrespective of AS severity, adding evidence and providing support to the important point that sex differences in valvular calcium concentration in AS does not reflect valvular size.
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Affiliation(s)
- Louise Linde
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark.,OPEN Open Patient data Explorative Network, Denmark
| | - Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark.,OPEN Open Patient data Explorative Network, Denmark
| | | | - Kristian Altern Øvrehus
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | | | - Kristian Laursen
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Pia Søndergaard Jensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark.,OPEN Open Patient data Explorative Network, Denmark.,Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jordi Sanchez Dahl
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
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24
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Mørk SR, Stengaard C, Linde L, Møller JE, Jensen LO, Schmidt H, Riber LP, Andreasen JB, Thomassen SA, Laugesen H, Freeman PM, Christensen S, Greisen JR, Tang M, Møller-Sørensen PH, Holmvang L, Gregers E, Kjaergaard J, Hassager C, Eiskjær H, Terkelsen CJ. Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a Danish nationwide multicenter study. Crit Care 2021; 25:174. [PMID: 34022934 PMCID: PMC8141159 DOI: 10.1186/s13054-021-03606-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 12/16/2022]
Abstract
Background Mechanical circulatory support (MCS) with either extracorporeal membrane oxygenation or Impella has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). The objective of this study was to describe the gradual implementation, survival and adherence to the national consensus with respect to use of MCS for OHCA in Denmark, and to identify factors associated with outcome. Methods This retrospective, observational cohort study included patients receiving MCS for OHCA at all tertiary cardiac arrest centers (n = 4) in Denmark between July 2011 and December 2020. Logistic regression and Kaplan–Meier survival analysis were used to determine association with outcome. Outcome was presented as survival to hospital discharge with good neurological outcome, 30-day survival and predictors of 30-day mortality. Results A total of 259 patients were included in the study. Thirty-day survival was 26%. Sixty-five (25%) survived to hospital discharge and a good neurological outcome (Glasgow–Pittsburgh Cerebral Performance Categories 1–2) was observed in 94% of these patients. Strict adherence to the national consensus showed a 30-day survival rate of 30% compared with 22% in patients violating one or more criteria. Adding criteria to the national consensus such as signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow < 100 min, pH > 6.8 and lactate < 15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (RR 1.20, 95% CI 1.03–1.41), initial pH < 6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels > 15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had reduced risk of 30-day mortality (RR 0.63, 95% CI 0.52–0.76). Conclusions A high survival rate with a good neurological outcome was observed in this Danish population of patients treated with MCS for OHCA. Stringent patient selection for MCS may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03606-5.
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Affiliation(s)
- Sivagowry Rasalingam Mørk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Carsten Stengaard
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Henrik Schmidt
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jo Bønding Andreasen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse Anette Thomassen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Laugesen
- Department of Anaesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Raben Greisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Mariann Tang
- Department of Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emilie Gregers
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
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25
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Ratcovich H, Josiassen J, Helgestad OKL, Linde L, Sadjadieh G, Engstrøm T, Jensen LO, Ravn HB, Schmidt H, Hassager C, Møller JE, Holmvang L. Incidence, Predictors, and Outcome of In-Hospital Bleeding in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction. Am J Cardiol 2021; 144:13-19. [PMID: 33383003 DOI: 10.1016/j.amjcard.2020.12.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 11/18/2022]
Abstract
Bleeding after acute myocardial infarction (AMI) is associated with an increased morbidity and mortality. The frequency and consequences of bleeding events in patients with AMICS are not well described. The objective was to investigate incidence and outcome of bleeding complications among unselected patients with AMI complicated by cardiogenic shock (AMICS) and referred for immediate revascularization. Bleeding events were assessed by review of medical records in consecutive AMICS patients admitted between 2010 and 2017. Bleedings during admission were classified according to Bleeding Academic Research Consortium classification. Patients who did not survive to admission in the intensive care unit were excluded. Of the 1,716 patients admitted with AMICS, 1,532 patients (89%) survived to ICU admission. At 30 days, mortality was 48%. Severe bleedings classified as BARC 3/5 were seen in 87 non-coronary bypass grafting patients (6.1%). Co-morbidity did not differ among patients; however, patients who had a BARC 3/5 bleeding had significantly higher lactate and lower systolic blood pressure at admission, indicating a more severe state of shock. The use of mechanical assist devices was significantly associated with severe bleeding events. Univariable analysis showed that patients with a BARC 3/5 bleeding had a significantly higher 30-day mortality hazard compared with patients without severe bleedings. The association did not sustain after multivariable adjustment (hazard ratio 0.90, 95% confidence interval 0.64; 1.26, p = 0.52). In conclusion, severe bleeding events according to BARC classification in an all-comer population of patients with AMICS were not associated with higher mortality when adjusting for immediate management, hemodynamic, and metabolic state. This indicates that mortality in these patients is primarily related to other factors.
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Affiliation(s)
- Hanna Ratcovich
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ole K L Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Golnaz Sadjadieh
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Hanne B Ravn
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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26
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Søholm H, Laursen ML, Kjaergaard J, Lindhardt TB, Hassager C, Møller JE, Gregers E, Linde L, Johansen JB, Winther-Jensen M, Lippert FK, Køber L, Philbert BT. Early ICD implantation in cardiac arrest survivors with acute coronary syndrome - predictors of implantation, ICD-therapy and long-term survival. SCAND CARDIOVASC J 2021; 55:205-212. [PMID: 33749460 DOI: 10.1080/14017431.2021.1900597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives. Implantable cardioverter defibrillator (ICD) implantation in patients resuscitated from out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI) is controversial. Design. Consecutive OHCA-survivors due to AMI from two Danish tertiary heart centers from 2007 to 2011 were included. Predictors of ICD-implantation, ICD-therapy and long-term survival (5 years) were investigated. Patients with and without ICD-implantation during the index hospital admission were included (later described as early ICD-implantation). Patients with an ICD after hospital discharge were censored from further analyses at time of implantation. Results. We identified 1,457 consecutive OHCA-patients, and 292 (20%) of the cohort met the inclusion criteria. An ICD was implanted during hospital admission in 78 patients (27%). STEMI and successful revascularization were inversely and independently associated with ICD-implantation (ORSTEMI = 0.37, 95% CI: 0.14-0.94, ORrevasc = 0.11, 0.03-0.36) whereas age, sex, LVEF <35%, comorbidity burden or shockable first OHCA-rhythm were not associated with ICD-implantation. Appropriate ICD-shock therapy during the follow-up period was noted in 15% of patients (n = 12). Five-year mortality-rate was significantly lower in ICD-patients (18% vs. 28%, plogrank = 0.02), which was persistent after adjustment for prognostic factors (HR = 0.44 (95% CI: 0.23-0.88)). This association was no longer found when using first event (death or appropriate shock whatever came first) as outcome variable (plogrank = 0.9). Conclusions. Mortality after OHCA due to AMI was significantly lower in patients with early ICD-implantation after adjustment for prognostic factors. When using appropriate shock and death as events, ICD-patients had similar outcome as patients without an ICD, which may suggest a survival benefit due to appropriate device therapy.
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Affiliation(s)
- Helle Søholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Marie L Laursen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Emilie Gregers
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Epidemiology, Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Freddy K Lippert
- Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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27
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Milling L, Linde L, Brøchner AC, Lassen JF, Mikkelsen S. [Treatment of out-of-hospital cardiac arrest with mechanical cardiopulmonary resuscitation]. Ugeskr Laeger 2020; 182:V04200273. [PMID: 32800048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This review provides a summary of treatment of cardiac arrest with mechanical cardiopulmonary resuscitation (CPR). CPR provides chest compressions according to guidelines in the treatment of out-of-hospital cardiac arrest. This is useful in situations where CPR cannot be safely delivered (e.g. during transportation and prolonged CPR). Randomized controlled trials have not shown improved patient outcomes after treatment with mechanical CPR compared to manual CPR. Mechanical CPR can, like manual CPR, cause injuries, and some may be life-threatening. Mechanical CPR is therefore recommended as an adjunct to manual CPR in special circumstances but not used routinely.
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28
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Møller-Helgestad OK, Hyldebrandt JA, Banke A, Rud CS, Udesen NLJ, Linde L, Okkels-Jensen L, Schmidt H, Ravn HB, Møller JE. Impella CP or VA-ECMO in profound cardiogenic shock: left ventricular unloading and organ perfusion in a large animal model. EUROINTERVENTION 2019; 14:e1585-e1592. [PMID: 30418160 DOI: 10.4244/eij-d-18-00684] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate the Impella CP over veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and their impact on left ventricular unloading and end-organ perfusion. METHODS AND RESULTS Cardiogenic shock (CS) was induced by injecting microspheres into the left coronary artery in fourteen adult female swine. Impella CP or VA-ECMO was initiated in the presence of CS and evaluated after 60 minutes. Left ventricular pressure-volume area (PVA, total mechanical work) was obtained from a conductance catheter. Results are presented as mean (95% confidence interval) and the rank-sum test was used to assess differences between devices. Compared to the CS state, PVA was unaffected by Impella CP and increased on VA-ECMO (from 2,548 [2,193; 2,904] mmHg x mL during CS to 5,775 [4,451; 7,099], between device p-value=0.02). Arterial lactate increased during CS and decreased on support with no difference between devices. Renal venous oxygen saturation decreased during CS and increased on support with no difference between devices. Cerebral venous oxygen saturation increased to 33% [25, 40] on Impella CP and to 69% [49, 89] on VA-ECMO, p=0.04. CONCLUSIONS In this porcine model of profound CS, Impella CP unloaded the left ventricle compared to VA-ECMO. Both devices improved end-organ perfusion, with a tendency towards higher venous oxygen saturations on VA-ECMO.
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Møller-Helgestad OK, Hyldebrandt JA, Udesen NLJ, Banke A, Rud CS, Linde L, Jensen L, Schmidt H, Ravn HB, Møller J. MECHANICAL CIRCULATORY SUPPORT BY VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION OR IMPELLA CP IN A PORCINE MODEL OF PROFOUND CARDIOGENIC SHOCK: IMPACT ON LEFT VENTRICULAR UNLOADING AND END ORGAN PERFUSION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31850-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Linde L, Sørensen J, Østergaard M, Hetland ML, Merete LH. Gain in quality-adjusted life-years in patients with rheumatoid arthritis during 1 year of biological therapy: a prospective study in clinical practice. J Rheumatol 2013; 40:1479-86. [PMID: 23818719 DOI: 10.3899/jrheum.121387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The quality-adjusted life-year (QALY) is used to measure outcome in rheumatoid arthritis (RA) studies; identification of drivers of a gain in QALY might help predict a treatment response. We investigated how changes in components of the Disease Activity Score-28 joints (DAS28) were associated with the European League Against Rheumatism (EULAR) and European Quality of Life 5 Dimensions (EQ-5D) responses; and what baseline variables predicted the change in QALY following 1 year of biological therapy. METHODS Data were collected at baseline and after 3, 6, and 12 months of biological therapy in Danish patients with RA and included bDAS28, sociodemographic data, comorbidity, Health Assessment Questionnaire (HAQ), and EQ-5D scored using the Danish algorithm. A cross-tabulation based on EULAR versus EQ-5D responses was performed, and the association of each DAS28 component across the EULAR/EQ-5D response groups was tested. Predictors of a change in QALY were assessed in a multiple regression model including baseline clinical and patient-reported data as explanatory variables. RESULTS In total, 315 patients entered the study; 77% were women, 78% IgM rheumatoid factor-positive, with mean age 55 (SD 13) years, disease duration 10 (SD 8) years, mean DAS28 4.9 (SD 1.2), HAQ score 1.22 (SD 0.70), and EQ-5D score 0.60 (SD 0.19). Sixty-eight percent of patients gained QALY; the mean gain was 0.14 (SD 0.13). The patient global score was strongly correlated with both EULAR and EQ-5D responses. The gain in QALY increased with increasing patient global score and number of swollen joints, but not with C-reactive protein (CRP). CONCLUSION The subjective patient global score was the best baseline predictor of gain in QALY following biological therapy, while the objective CRP measure had no predictive value. It seems that no sharp demarcation between objective and subjective measures could be determined.
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Affiliation(s)
- Louise Linde
- The DANBIO Registry, the Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark.
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Linde L, Sørensen J, Østergaard M, Hetland M. AB0304 Predictors of gain in quality adjusted life years in RA patients treated with biologics for one year:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dreyer L, Mellemkjær L, Andersen AR, Bennett P, Poulsen UE, Juulsgaard Ellingsen T, Hansen TH, Jensen DV, Linde L, Lindegaard HM, Loft AGR, Nordin H, Omerovic E, Rasmussen C, Schlemmer A, Tarp U, Hetland ML. Incidences of overall and site specific cancers in TNFα inhibitor treated patients with rheumatoid arthritis and other arthritides – a follow-up study from the DANBIO Registry. Ann Rheum Dis 2012; 72:79-82. [DOI: 10.1136/annrheumdis-2012-201969] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sørensen J, Linde L, Ostergaard M, Hetland ML. Quality-adjusted life expectancies in patients with rheumatoid arthritis--comparison of index scores from EQ-5D, 15D, and SF-6D. Value Health 2012; 15:334-339. [PMID: 22433765 DOI: 10.1016/j.jval.2011.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 09/22/2011] [Accepted: 09/30/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND The aim of this study was to compare quality-adjusted life expectancy (QALE) for patients with rheumatoid arthritis generated from three generic health-related quality-of-life instruments. METHODS Patients from 11 Danish rheumatology outpatient clinics were asked to report current health status using the EuroQol five-dimensional questionnaire (EQ-5D), 15D, and six-dimensional health state short form (derived from SF-12) (SF-6D) instruments. Clinical staff provided data on current disease status (C-reactive protein and Disease Activity Score that involves clinical assessment of 28 joints). National mortality data were retrieved from Statistics Denmark. For each of the three instruments, mean index scores were estimated by gender and 5-year age groups. Partial QALE was estimated for the age interval 30 to 79 years for different subsamples. RESULTS Although the three quality-of-life index scores were highly correlated, there were statistically significant differences between the average index scores from the three instruments. The 15D provided the highest index score and SF-6D the lowest score. For a 30-year-old patient, the partial QALE ranged from 37.9 quality-adjusted life-years using the SF-6D to 45.6 quality-adjusted life-years using the 15D. The QALE for men and women differed by 6.2%, 4.0%, and 5.3% when the calculation was based on EQ-5D, SF-6D, and 15D index scores, respectively. The largest differences were observed when patients were grouped by functional status (Health Assessment Questionnaire score), where the EQ-5D showed a 50% difference in index score between the best and worst functional group while the SF-6D and 15D showed smaller differences (32% and 14%, respectively). DISCUSSION This analysis has shown the difference in QALE estimates related to different instruments. The study emphasizes that unless outcome studies use the same instruments and scoring algorithms, the results will not be directly comparable.
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Affiliation(s)
- Jan Sørensen
- Center for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark.
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Søgaard R, Sørensen J, Linde L, Hetland ML. The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis. Clinicoecon Outcomes Res 2010; 2:105-12. [PMID: 21935319 PMCID: PMC3169960 DOI: 10.2147/ceor.s11492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Indexed: 11/23/2022] Open
Abstract
Lost production can be due to individuals' time lost to work (absenteeism), as well as their time at work with reduced productivity because of ill health (presenteeism). A sound methodological framework for the assessment of presenteeism remains to be established but given its significance, ignoring it would lead to severe underestimations, eg, in cost-of-illness studies. The objective of this study was to assess the empirical significance of absenteeism and presenteeism in terms of production loss using the case of rheumatoid arthritis (RA). Selected modules from the Health and Labor Questionnaire were applied in a cross-sectional study of 3,704 patients with RA. The costs of absenteeism and presenteeism were estimated using the Human Capital approach, and the impact of including multipliers adjusting for the productivity effect of a workers' absence or impaired presenteeism on societal productivity was demonstrated. RA-related absenteeism over the last 14 days was 22.31 hours (standard deviation [SD], 26.51) with a resulting cost of €473 (SD, 575) and €762 (SD, 926) depending on whether a multiplier was included. Presenteeism was found to affect 7.98 (SD, 3.24) working days over the last 14 days with a resulting cost of €168 (SD, 203) and €203 (SD, 245), again depending on whether a multiplier was included. Overall, this article demonstrates that the value of lost production due to RA could be subject to an almost factor 2 increase if productivity effects of presenteeism and general multipliers are included.
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Affiliation(s)
- Rikke Søgaard
- CAST - Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Denmark
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Hetland ML, Christensen IJ, Tarp U, Dreyer L, Hansen A, Hansen IT, Kollerup G, Linde L, Lindegaard HM, Poulsen UE, Schlemmer A, Jensen DV, Jensen S, Hostenkamp G, Østergaard M. Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry. ACTA ACUST UNITED AC 2010; 62:22-32. [PMID: 20039405 DOI: 10.1002/art.27227] [Citation(s) in RCA: 394] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare tumor necrosis factor alpha inhibitors directly regarding the rates of treatment response, remission, and the drug survival rate in patients with rheumatoid arthritis (RA), and to identify clinical prognostic factors for response. METHODS The nationwide DANBIO registry collects data on rheumatology patients receiving routine care. For the present study, we included patients from DANBIO who had RA (n = 2,326) in whom the first biologic treatment was initiated (29% received adalimumab, 22% received etanercept, and 49% received infliximab). Baseline predictors of treatment response were identified. The odds ratios (ORs) for clinical responses and remission and hazard ratios (HRs) for drug withdrawal were calculated, corrected for age, disease duration, the Disease Activity Score in 28 joints (DAS28), seropositivity, concomitant methotrexate and prednisolone, number of previous disease-modifying drugs, center, and functional status (Health Assessment Questionnaire score). RESULTS Seventy percent improvement according to the American College of Rheumatology criteria (an ACR70 response) was achieved in 19% of patients after 6 months. Older age, concomitant prednisolone treatment, and low functional status at baseline were negative predictors. The ORs (95% confidence intervals [95% CIs]) for an ACR70 response were 2.05 (95% CI 1.52-2.76) for adalimumab versus infliximab, 1.78 (95% CI 1.28-2.50) for etanercept versus infliximab, and 1.15 (95% CI 0.82-1.60) for adalimumab versus etanercept. Similar predictors and ORs were observed for a good response according to the European League Against Rheumatism criteria, DAS28 remission, and Clinical Disease Activity Index remission. At 48 months, the HRs for drug withdrawal were 1.98 for infliximab versus etanercept (95% 1.63-2.40), 1.35 for infliximab versus adalimumab (95% CI 1.15-1.58), and 1.47 for adalimumab versus etanercept (95% CI 1.20-1.80). CONCLUSION Older age, low functional status, and concomitant prednisolone treatment were negative predictors of a clinical response and remission. Infliximab had the lowest rates of treatment response, disease remission, and drug adherence, adalimumab had the highest rates of treatment response and disease remission, and etanercept had the longest drug survival rates. These findings were consistent after correction for confounders and sensitivity analyses and across outcome measures and followup times.
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Affiliation(s)
- Merete Lund Hetland
- DANBIO Registry, Copenhagen University Hospital, Department of Rheumatology, Hvidovre, Denmark.
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Linde L, Sørensen J, Østergaard M, Hørslev-Petersen K, Hetland ML. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of remission criteria important? J Rheumatol 2010; 37:285-90. [PMID: 20080905 DOI: 10.3899/jrheum.090898] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare health-related quality of life (HRQOL) of patients with rheumatoid arthritis (RA) to that of the general population and to investigate the association with disease activity, focusing on different clinical remission criteria. METHODS EQ-5D data from 3156 patients with RA from 11 Danish centers were compared with Danish EQ-5D population norms (n = 16,136). The Disease Activity Score (DAS28) and the Clinical Disease Activity Index score (CDAI) were used as definitions of disease activity and clinical remission. The score difference (DeltaEQ-5D) was calculated in each patient as the difference from the age and sex-matched general population and adjusted for age, marital status, education, body mass index, smoking, exercise habits, disease duration, IgM-rheumatoid factor status, joint surgery, extraarticular features, treatment, and comorbidity in multiple linear regression models. RESULTS 37% vs 22% fulfilled the DAS28 and CDAI remission criteria, respectively. The DeltaEQ-5D values for women/men in clinical remission were DAS28 0.05/0.06 vs CDAI 0.01/0.02; low disease activity: DAS28 0.12/0.13 vs CDAI 0.11/0.14; moderate disease activity: DAS28 0.18/0.20 vs CDAI 0.20/0.23; and high disease activity: DAS28 0.38/0.28 vs CDAI 0.33/0.26. Adjusting for confounders reduced the DeltaEQ-5D values between 0 and 0.04 units. CONCLUSION Patients with RA had worse EQ-5D scores than the general population, and the difference was strongly associated with disease activity. The EQ-5D score for patients in clinical remission approached that of the general population, suggesting that strict treatment goals are critical in order to achieve near-normal HRQOL in patients with RA.
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Affiliation(s)
- Louise Linde
- Department of Rheumatology, Copenhagen University Hospital, Hvidovre, Denmark.
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Linde L, Sørensen J, Østergaard M, Hørslev-Petersen K, Rasmussen C, Jensen DV, Hetland ML. What factors influence the health status of patients with rheumatoid arthritis measured by the SF-12v2 Health Survey and the Health Assessment Questionnaire? J Rheumatol 2009; 36:2183-9. [PMID: 19723897 DOI: 10.3899/jrheum.090134] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome measure in rheumatoid arthritis (RA), whereas the SF-12v2 Health Survey (SF-12) was introduced recently. We investigated how the HAQ and SF-12 were associated with socio-demographic, lifestyle, and disease- and treatment-related factors in patients with RA. METHODS In RA patients from 11 Danish centers, clinical and patient-reported data, including the HAQ and SF-12, were collected. Three multiple linear regression models were estimated, with the HAQ, SF-12 physical component score (PCS), and SF-12 mental component score (MCS) as outcome and sociodemographic, lifestyle, and RA-related treatment and comorbidity characteristics as explanatory variables. RESULTS In total, 3156 (85%) of 3704 invited patients participated--75% women, 76% rheumatoid factor-positive, median age 61 years (range 15-93 yrs), disease duration 7 years (range 0-68 yrs), Disease Activity Score on 28 joints (DAS28) 2.97 (range 0.96-8.61), HAQ score 0.63 (range 0-3), SF-12 PCS 56 (range 6-99), and SF-12 MCS 57 (range 16-99). Variation in HAQ was associated with 12 of 15 possible variables (R(2) 0.41), in PCS and MCS with 6 of 15 variables (R(2) 0.02 and 0.05). Patients with moderate to high DAS28 and > or = 3 comorbid conditions had consistently worse HAQ and SF-12 scores compared to the reference groups, while weekly exercise was associated with better scores compared to no exercise. CONCLUSION The HAQ was more sensitive to differences in demographic, lifestyle, and disease- and treatment-related factors than the SF-12. The established clinical value and feasibility of the HAQ highlights its advantages over the SF-12 in describing health status in RA.
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Affiliation(s)
- Louise Linde
- Department of Rheumatology, Hvidovre Hospital, 232 Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
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Linde L, Hetland ML, Ostergaard M. Drug survival and reasons for discontinuation of intramuscular methotrexate: a study of 212 consecutive patients switching from oral methotrexate. Scand J Rheumatol 2009; 35:102-6. [PMID: 16641042 DOI: 10.1080/03009740500343294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the drug survival and reasons for discontinuation of intramuscular methotrexate (imMTX) in rheumatological patients who had switched to imMTX from oral methotrexate (oMTX). METHODS Data from 212 consecutive patients who switched from oMTX to imMTX therapy at our outpatient clinic between April 1997 and January 2004 were collected retrospectively through survey of case records. Data included reason for discontinuation of oMTX, disease activity parameters, duration of imMTX therapy, and, in patients who withdrew, the reason for discontinuation of imMTX. RESULTS The main reasons for switching from oMTX to imMTX were lack of efficacy (66%) and adverse events (28%). After 6 months, 114 patients (54%) were still receiving imMTX therapy, and their median serum C-reactive protein (CRP) and the percentage of patients who had received glucocorticoids during the previous 6 weeks had decreased (p<0.001). The median survival of imMTX therapy was 7.5 months (interquartile range 3-17). Twenty per cent of the patients received imMTX for more than 24 months. Of the 212 patients, 41% and 9% stopped imMTX therapy because of lack of efficacy and adverse events, respectively. Of the patients who had stopped oMTX because of adverse events, 22% also withdrew from imMTX because of adverse events. CONCLUSION Half of the patients benefited from switching from oral to intramuscular methotrexate for at least 6 months, but only a minority adhered to the treatment for years. Lack of efficacy was the most frequent reason for discontinuation, while adverse events were rare.
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Affiliation(s)
- L Linde
- Department of Rheumatology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
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Ostergaard M, Unkerskov J, Linde L, Krogh NS, Ravn T, Ringsdal VS, Petri A, Andersen LS, Tarp U, Hansen A, Hjardem E, Hetland ML. Low remission rates but long drug survival in rheumatoid arthritis patients treated with infliximab or etanercept: results from the nationwide Danish DANBIO database. Scand J Rheumatol 2009; 36:151-4. [PMID: 17476624 DOI: 10.1080/03009740601089267] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Linde L, Sørensen J, Ostergaard M, Hørslev-Petersen K, Hetland ML. Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol 2008; 35:1528-1537. [PMID: 18484697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To compare validity, reliability, and responsiveness of generic and disease specific health-related quality of life (HRQOL) instruments in rheumatoid arthritis (RA). METHODS Two samples of patients completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), EuroQol (EQ)-5D, 15D, Rheumatoid Arthritis Quality of Life Scale (RAQoL), Health Assessment Questionnaire (HAQ), and visual analog scales (VAS) for pain, fatigue, and global RA. VALIDITY (convergent, discriminant, and known-groups) was evaluated in a cross-section of 200 patients. Reliability was evaluated by agreement (intraclass correlation coefficient; baseline to 2 weeks) and internal consistency (Cronbach's alpha); and responsiveness by the standardized response mean stratified on improvement, status quo, or deterioration in health status after 6 months in 150 patients followed longitudinally. Followup questionnaires (at 2 weeks and 6 months) included questions about changes in health status since baseline. RESULTS The cross-sectional sample included 77% women, median age 57 years (range 19-87), disease duration 6 years (0-58), with Disease Activity Score 28-joint count (DAS28) of 3.10 (1.21-6.47). The longitudinal sample included 80% women, median age 60 years (22-82). VALIDITY all instruments discriminated between low, moderate, and high DAS28. Reliability: RAQoL and HAQ displayed good repeatability (ICC > 0.95) and internal consistency (Cronbach's alpha > 0.90). Responsiveness: SF-36 bodily pain scale and VAS pain were responsive to both improvement and deterioration. CONCLUSION All instruments were valid measures for HRQOL in RA. The RAQoL and HAQ displayed the best reliability, while the SF-36 bodily pain scale and VAS pain were the most responsive. The choice of instrument should depend on the study objectives.
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Affiliation(s)
- Louise Linde
- Department of Rheumatology, Copenhagen University Hospital, Hvidovre, Denmark.
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Linde L, Sørensen J, Østergaard M, Hetland ML. [Health-related quality of life of patients with rheumatoid arthritis. Which factors are of significance?]. Ugeskr Laeger 2008; 170:855-858. [PMID: 18364173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease causing joint pain, loss of function and decreased health-related quality of life (HRQoL). HRQoL in RA patients is associated with several risk factors; in this paper the evidence relating to the most important risk factors is reviewed. Modern medical therapy has improved HRQoL in RA patients, while demographic factors (female sex and older age), low socioeconomic status (in terms of education and position in the work force) and the presence of comorbid conditions appear to be associated with poorer HRQoL.
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Abstract
The reduction of oxygen levels is a technique used both for fire fighting and fire protection in confined spaces. The purpose of this study was to find out if and how reduced oxygen levels affect cognitive performance in a small group of persons living in a confined space such as a submarine. In 3 separate experiments lasting for 11 to 14 days, a total of 22 men were exposed to normoxic and different levels of hypoxic normobaric atmospheres (15, 14, and 13 kPa O2). Each participant completed a cognitive test battery twice every 24-hr period in the first 2 experiments, but only once a day in the 3rd experiment. Performance in almost all tests improved with the number of test sessions performed, despite reductions of the oxygen partial pressure. Under the conditions tested, cognitive performance decrements could not be observed if inspiratory oxygen partial pressure was kept above 13 kPa.
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Affiliation(s)
- L Linde
- Department of Naval Medicine, National Defense Research Establishment, Stockholm, Sweden
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Linde L, Edland A, Bergström M. Auditory attention and multiattribute decision-making during a 33 h sleep-deprivation period: mean performance and between-subject dispersions. Ergonomics 1999; 42:696-713. [PMID: 10327892 DOI: 10.1080/001401399185397] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
One purpose of this study was to compare attention in the evening (22:00 h), in the late night (04:00 h), in the morning (10:00 h) and in the afternoon (16:00 h) during a period of complete wakefulness beginning at 08:00 h with a mean daytime performance without sleep deprivation. Another purpose was to investigate sleep deprivation effects on a multi-attribute decision-making task with and without time pressure. Twelve sleep-deprived male students were compared with 12 male non-sleep-deprived students. Both groups were tested five times with an auditory attention and a symbol coding task. Significant declines (p < 0.05) in mean level of performance on the auditory attention task were found at 04:00, 10:00 and 16:00 h for subjects forced to the vigil. However, the effect of the sleep deprivation manifested itself even more in increased between-subject dispersions. There were no differences between time pressure and no time pressure on the decision-making task and no significant differences between sleep-deprived and non-sleep-deprived subjects in decision strategies. In fact, the pattern of decision strategies among the sleep-deprived subject was more similar to a pattern of decision strategies typical for non-stressful conditions than the pattern of decision strategies among the non-sleep-deprived subjects. This result may have been due to the fact that the sleep loss acted as a dearouser. Here too, however, the variances differed significantly among sleep-deprived and non-sleep-deprived subjects, indicating that the sleep-deprived subjects were more variable in their decision strategy pattern than the control group.
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Affiliation(s)
- L Linde
- Department of Human Sciences, National Defense Research Establishment, Linköping, Sweden
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Linde L, Balldin U. Arm pain among Swedish fighter pilots during +Gz flight and centrifuge exposures. Aviat Space Environ Med 1998; 69:639-42. [PMID: 9681369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose was to survey the occurrence of arm pain among Swedish fighter or test pilots in connection with exposures to high +Gz load when flying or performing centrifuge tests. HYPOTHESIS +Gz induced arm pain occurs in connection with high +Gz loads in flight as well as in centrifuge tests of high performance fighter pilots. METHODS A questionnaire was used for data collection regarding +Gz induced arm pain. Respondents were 35 Swedish Air Force Viggen and Gripen fighter pilots who had previously participated as subjects in centrifuge tests between 1990 and 1995 at Brooks Air Force Base, TX, either with the standard anti-G suit or with extended coverage anti-G suit with pressure breathing during +Gz. RESULTS Of the respondents, 55% reported that they had experienced arm pain during flight at least once and 42% experienced it more than three times. However, arm pain was more common in the centrifuge tests (82% once; and 42% more than 3 times). CONCLUSIONS Presence of arm pain during high performance fighter aircraft flights is a phenomenon that should be taken into consideration when designing high performance aircraft or +Gz protective equipment.
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Affiliation(s)
- L Linde
- Department of Human Studies, National Defence Research Establishment, Stockholm, Sweden
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Linde L, Jensen KF. Uracil phosphoribosyltransferase from the extreme thermoacidophilic archaebacterium Sulfolobus shibatae is an allosteric enzyme, activated by GTP and inhibited by CTP. Biochim Biophys Acta 1996; 1296:16-22. [PMID: 8765224 DOI: 10.1016/0167-4838(96)00045-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Uracil phosphoribosyltransferase, which catalyses the formation of UMP and pyrophosphate from uracil and 5-phosphoribosyl alpha-1-pyrophosphate (PRPP), was partly purified from the extreme thermophilic archaebacterium Sulfolobus shibatae. The enzyme required divalent metal ions for activity and it showed the highest activity at pH 6.4. The specific activity of the enzyme was 50-times higher at 95 degrees C than at 37 degrees C, but the functional half-life was short at 95 degrees C. The activity of uracil phosphoribosyltransferase was strongly activated by GTP, which increased Vmax of the reaction by approximately 20-fold without much effect on K(m) for the substrates. The concentration of GTP required for half-maximal activation was about 80 microM. CTP was a strong inhibitor and acted by raising the concentration of GTP needed for half-maximal activation of the enzyme. We conclude that uracil phosphoribosyltransferase from S. shibatae is an allosteric enzyme which is activated by a purine nucleotide and inhibited by a pyrimidine nucleotide as seen for several enzymes in the pyrimidine nucleotide biosynthetic pathway of Escherichia coli, but not observed before for any phosphoribosyltransferase.
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Affiliation(s)
- L Linde
- Center for Enzyme Research, Institute of Molecular Biology, University of Copenhagen, Denmark
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Abstract
In experiment 1 eight male and eight female subjects were randomly assigned to either a caffeine or a placebo condition. Caffeine (150 mg) was given at midnight and at 4 a.m. Oral temperature, subjective ratings of fatigue and mood, and performance in two cognitive tasks (an auditive attention task and a visual coding task) were assessed. Subjective 'drowsiness' and 'tiredness' increased significantly more in subjects given placebo than in subjects given caffeine treatment. The effects of drug treatment in performance and temperature were non-significant. However, the temperature of female subjects increased between midnight and 4 a.m. and the temperature of male subjects decreased during the same period of time. On the other hand, at 5 a.m. female subjects rated themselves as more sleepy, tired and 'disorganized' than the male subjects. In experiment 2 nine female and nine male subjects were assigned randomly to either placebo or caffeine treatment. Caffeine (200 mg) was given at 5 a.m. Oral temperature, subjective ratings of fatigue and mood, and level of performance in three cognitive tasks (the same as above plus Raven's progressive matrices) were assessed. Moreover, the subjects rated the effort of performing each task. The effects of drug treatment in level of performance were non-significant. However, the subjective effort of performing the auditive attention task increased significantly in subjects given placebo treatment, suggesting a compensatory arousal mechanism (Broadbent 1971). The effect of gender on temperature was non-significant. There was a significant interaction between gender and treatment in respect of subjective effort of performing the matrices task. In men caffeine decreased subjective effort and in women subjective effort was increased by caffeine. Experiment 3 was set up to investigate the hypothesis that negative effects of caffeine in women, observed in experiment 2, were due to over-optimal ('vigilance-related') arousal for the visual coding and matrices tasks. Ten female and eight male non-sleep deprived subjects were given 200 mg caffeine or placebos at 3 p.m. and tested at 4 p.m. Experiment 3 was not found to support the over-optimal 'vigilance-related-arousal' hypothesis. Effects of caffeine in performance and effort were non-significant in experiment 3. Combining data from experiments 2 and 3 gave a significant three-way interaction between caffeine, time for experiment and rule complexity in the visual coding task. When there was a complex rule, caffeine was found to have a positive effect in experiment 3 and a negative effect in experiment 2.
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Affiliation(s)
- L Linde
- National Defence Research Establishment, Dept. 5, Stockholm, Sweden
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Abstract
On an auditory attention task subjects were required to reproduce spatial relationships between letters from auditorily presented verbal information containing the prepositions "before" or "after." It was assumed that propositions containing "after" induce a conflict between temporal, and semantically implied, spatial order between letters. Data from 36 subjects showing that propositions with "after" are more difficult to process are presented. A significant, general training effect appeared. 200 mg caffeine had a certain beneficial effect on performance of 18 subjects who had been awake for about 22 hours and were tested at 6 a.m.; however, the beneficial effect was not related to amount of conflict but concerned items without and with conflict. On the other hand, the effect of caffeine for 18 subjects tested at 4 p.m. after normal sleep was slightly negative.
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Affiliation(s)
- L Linde
- National Defense Research Establishment, Sundbyberg, Sweden
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Abstract
The aim of the study was to investigate the effect of spending one night without sleep on the performance of complex cognitive tasks, such as problem-solving, in comparison with a purely short-term memory task. One type of task investigated was immediate free recall, assumed to reflect the holding capacity of the working memory. The other type of task investigated was represented by syntactical reasoning and problem-solving tasks, assumed to reflect the processing (the mental transformation of input) and monitoring capacity of the working memory. Two experiments with a repeated-measures design were performed. Experiment 1 showed a significant decline in performance as a function of sleep loss on Raven's progressive matrices, a problem-solving task. No other main effect of sleep loss was found. Experiment 2 had a different order between tasks than Experiment 1 and the time without sleep was increased. A number-series induction task was also used in Experiment 2. A significant, negative effect of sleep loss in performance on Raven's progressive matrices was found in Experiment 2. The effects of sleep loss on the other tasks were nonsignificant. It is suggested that Raven's progressive-matrices task reflects the ability to monitor encoding operations (selective attention) and to monitor mental "computations".
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Affiliation(s)
- L Linde
- National Defense Research Establishment, Department 5, Human Studies, Sundbyberg, Sweden
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Linde L. [Bedside diagnosis of congenital heart disease]. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1966; 7:50-3. [PMID: 5945135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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