Suchergebnisse

The flow-dependent left ventricle overload is a well-known complication of the veno-arterial extracorporeal membrane oxygenation in a severe cardiogenic shock, which leads to a distension of the left ventricle and, frequently, to a severe pulmonary edema. Recently, an unloading of the left ventricle using a catheter inserted to the left ventricle and connected to the extracorporeal membrane oxygenation circuit has been proposed. The computational method was used to simulate the blood flow in the extracorporeal membrane oxygenation system with a drainage catheter incorporated to the left ventricle and connected to the inflow part of the extracorporeal membrane oxygenation circuit by a Y-shaped connector. The whole system was modelled in Modelica modelling language. The impact of various catheter sizes (from 5 Fr to 10 Fr) and extracorporeal blood flow values (from 1L/min to 5 L/min) were investigated. In our simulation model, the extracorporeal blood flow only modestly affected the value of volume that was withdrawn from the left ventricle by a catheter. Conversely, the size of the drainage catheter was the principal factor responsible for the achievement of the adequate left ventricle decompression. A 10 Fr drainage catheter, inserted into the left ventricle and connected to the venous part of the ECMO system, presents a promising solution to the unloading of the left ventricle during a extracorporeal membrane oxygenation.

BackgroundExperimental and clinical evidence supports the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis.MethodsWe performed a randomized, double-blind trial involving patients recruited within 30 days after a myocardial infarction. The patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily) or placebo. The primary efficacy end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization. The components of the primary end point and safety were also assessed.ResultsA total of 4745 patients were enrolled; 2366 patients were assigned to the colchicine group, and 2379 to the placebo group. Patients were followed for a median of 22.6 months. The primary end point occurred in 5.5% of the patients in the colchicine group, as compared with 7.1% of those in the placebo group (hazard ratio, 0.77; 95% confidence interval [CI], 0.61 to 0.96; P = 0.02). The hazard ratios were 0.84 (95% CI, 0.46 to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73) for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50 (95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to coronary revascularization. Diarrhea was reported in 9.7% of the patients in the colchicine group and in 8.9% of those in the placebo group (P = 0.35). Pneumonia was reported as a serious adverse event in 0.9% of the patients in the colchicine group and in 0.4% of those in the placebo group (P = 0.03).ConclusionsAmong patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo. (Funded by the Government of Quebec and others; COLCOT ClinicalTrials.gov number, NCT02551094.).